Quick hits: E15 'Stop the Stall' campaign; popcorn history; Connecticut's bid to attract first responders; Tolkien for men

Rural Voices USA photo

When the congressional Rural Domestic Energy Council failed to meet its Feb. 15 deadline to pass year-round E15 legislation, Rural Voices USA began targeted billboard campaigns in Iowa, Michigan, Minnesota, Nebraska and Wisconsin. WisPolitics-State Affairs reports, "The billboards, part of a six-figure multi-channel pressure campaign, are now live on digital boards. . . .The campaign targets districts represented by Republican champions of E15 legislation who have been unable to move the bill through congressional leadership." Allowing E15 year-round would help corn farmers secure a reliable, domestic income that isn't subject to export volatility.

March has arrived, but in many parts of the U.S., the snow hasn't left. In fact, there are still piles and piles of it everywhere. Victoria Hoffmann of the Christian Science Monitor wondered where a city like Boston, which received more than 5 feet of snow this winter, put all their snow. The answer: Snow farms. "My search led me on a journey to places in Boston I’ve never ventured before. Boston is operating 14 snow farms this year, the first time in years that a mayor ordered that many to be opened."

At first, U.S. movie theaters didn't want to sell 'the noisy
snack.' (Photo by M. Ingvordsen, Unsplash)

Heading to the movies didn't always include a bucket of popcorn. "At first, theater owners wanted nothing to do with the noisy snack. But then came the Great Depression," reports Heidi Mitchell of The Wall Street Journal. "The appeal was obvious: It was cheap, fast and theatrical. Families popped it over wood stoves; peddlers sold it in paper cones at circuses. . . .A whiff of fresh corn could draw a crowd quicker than any barker’s repetitive shout." Read about popcorn's history in the U.S. here.

In a bid to attract more first responders, Connecticut plans to offer recruits a range of incentives. Gov. Ned Lamont's bill, H.B. 5046, "would waive tuition to the state’s public colleges and universities for people who have worked as police officers for at least five years and for people who have served as paid or volunteer firefighters for at least five years," reports Emilia Otte of the CT Mirror. "The bill also authorizes the Connecticut Housing Finance Authority to create a mortgage assistance program for police officers and firefighters."

J.R.R. Tolkien's Lord of the Rings trilogy has taken millions of readers on what is arguably the most epic rural adventure -- to Mordor and back again. And while the tales of Bilbo and Frodo remain strikingly popular, they continue to have a more dramatic appeal for men. "Both Tolkien’s cosmic vision of Middle-earth and the many genuine heroes that populate his work likely make for an attractive combination in the eyes of many a meaning-starved young man," writes Peter Biles for The Dispatch. "As I wrote for The Dispatch a few months ago, boys don’t just automatically become good men in a vacuum; they need role models. Manhood must be carefully nurtured. . ."

The Great Florida Cattle Drive celebrates the Sunshine State's ranching heritage.
(Great Florida Cattle Drive photo)

When it comes to cowboys and cattle, most Americans tend to think of the West, but in early America, Florida was where the cattle and the cowboys traveled together. In a tribute to the state's history, "nearly 300 people and 300 head of cattle traveled a century back in time for the 5th iteration of the Great Florida Cattle Drive," reports Isaac Eger for National Geographic. Over six days and six nights the drive became "a living history reenactment where hundreds of riders on horseback walk, trot, canter, and gallop through 54 miles of pristine Florida country that is now part of the Florida Wildlife Corridor." Read about their adventure here.

Editor in North Carolina had to balance his storm-reporting duties with his other roles as a firefighter and EMT

Moss Brennan

Moss Brennan is editor of the Watauga Democrat newspaper in western North Carolina, and he also is a volunteer firefighter and an emergency medical technician. As Lauren Watson reports for Columbia Journalism Review, Brennan had to balance those roles as the flooding and winds from Helene led to extensive damage and hundreds of emergency rescues where he lives and works. 

In addition to his job at the Watauga newspaper, Brennan also is executive editor of Mountain Times Publications, which serves three rural counties in the region. 

As Watson reported, "In the days leading up to the arrival of Hurricane Helene last week, he was preparing for what he imagined would be some flooding and structural damage — possibly a handful of dramatic rescue missions — to report on. But he never anticipated the breadth of devastation and destruction that Helene would ultimately bring."

When the storm hit, Brennan first focused on his emergency services duties. “'If there is somebody that is hurt or their life is on the line, that comes first, before the story,'' he told Watson. "Balancing the two roles can be tricky ('I’m human, so it’s not perfect'), but Brennan also recognizes the responsibility that comes with his newspaper job."

Brennan told Watson: "I oversee the papers in Ashe, Watauga, and Avery counties, and during the week, we were the only outlet able to offer regular updates and reports to those communities."

As he delivered papers to people throughout the devastated communities, he found them welcoming of trustworthy information the newspapers provided. "I met people who told me that this was the first news they had gotten since last week.

"The Watauga County emergency services also asked for a bunch of papers so that their own damage assessment teams could give them out to people who lost everything and had no information about what was going on."

Rural Nebraskans look to the state for help with ailing emergency services

Rural Nebraskans often wait 25 minutes for an
ambulance. (Photo by Jonnica Hill, Unsplash)

Rural ambulance services have been short on volunteers for years, but in states like Nebraska, the situation has become so extreme with slowed response times and long drives to get medical care, residents are asking their state government to help, reports Adam Sanderford of the Nebraska Examiner. "Rural Nebraskans who wait longer than their urban peers for ambulances to arrive and then deliver a patient to a hospital told state lawmakers that many of their local emergency medical service providers need state help to stay afloat. . . . The interim study hearing sought by State Sen. Myron Dorn drew testimony from first responders and hospital groups. Many shared steps Nebraska could take to help smaller communities recruit, train and retain more emergency medical responders."

Volunteer fire and rescue squads are common in Nebraskan communities, but "many struggle to replace older helpers. Additionally, as the rural population ages, calls for service are up, adding pressure to the volunteers who remain," Sanderford writes. "Dorn said this means farmers and rural employees leave their jobs more often, making it harder to persuade a generation of young people to help. It's also harder to recruit volunteers from among younger adults who have children at home, busy with activities."

Nebraska is one of three states with the highest rates of rural residents living more than a 25-minute drive from where an ambulance is stationed, according to a national study by the Maine Rural Health Research Center. "More than 76% of the state's counties had some residents living at least that far from a station," Sanderford writes. "Dwyer told State Sen. Ben Hansen of Blair that no state has all the answers for providing rural EMS service. However, he said, many states spend more on addressing the issues than Nebraska. . . . In 2022, South Dakota earmarked up to $20 million for emergency medical services. This money appears poised to boost rural EMS service, from EMT training to helping smaller communities replace old equipment and access telemedicine."

At the hearing, rural first responders "called on the state to pay upfront for training new potential emergency medical responders and medical technicians instead of making them or their volunteer departments seek reimbursement," Sanderford reports. "Angela Ling of the Nebraska Hospital Association stressed the importance of the state seriously discussing the impact on rural rescue squads of inadequate Medicare and Medicaid reimbursements that leave EMS agencies fighting to make up the differences."

"One testifier, Wahoo EMS director Grant Anderson, called on the state to address in state law which levels of government should shoulder what costs of emergency medical services," Saderford writes. "Wahoo, pop. 4, 800, and Ashland, pop. 3,100, provide EMS services beyond the city limits, but only city taxpayers pay the costs beyond what fees cover. . . . Nebraska state law requires EMS service as an essential service, but it does not specify which level of government should fund the service." Commenting on the state's plans, Ling told Sanderford: “I do not have the solution but hope this is the beginning of a conversation.”

Another fish fry? Why local emergency medical services have so many fundraisers; here's what you can do to help

Rural ambulance in Sweetwater, Wyoming
(Photo by Kim Raff, The New York Times)

Another fish fry, ticket raffle or silent auction? Many of us would like to take a hard pass, possibly for life. But those fundraising efforts are the life of some emergency medical services across rural America. "If you don't do the fundraising, how do you pay for equipment needed to keep those people safe on a job for which they receive no pay?" Donna Kallner reports for The Daily Yonder. "It all adds up. It also takes a toll. When unpaid volunteers spend so much time fundraising, they have less time available for training, equipment checks, and other tasks – including paperwork, without which you don't get funding."

Kallner provides a personal example: "My rural volunteer fire department just purchased a new self-contained breathing apparatus. Those air packs include a frame that holds a pressurized cylinder containing breathable air, a mouthpiece and a regulator. . . . It wasn't cheap. Each new 45-minute pack with a cylinder was $7,500, and spare bottles were $900 each. . . . It took two years of fundraising to raise the $50,000 needed to put that new equipment into service."

What some residents may not know is that fire services impact family budgets. Kallner explains, "What those households pay for homeowners insurance is directly related to the readiness and reliability of the fire department that serves them. That's true in other rural areas, as well. . . . . Homeowners' insurance rates factor in ISO ratings. Those are determined by the Insurance Services Office, which assigns fire departments a score between 1 and 10. A score of 1 is the safest bet that an insurance company won't have to pay out on fire claims. Any area over five driving miles from the nearest fire station is automatically rated a 10."

"Like the rural households they serve, rural volunteer firefighters often pay a premium for homeowners insurance based on where they live. But they show up to flip flapjacks to pay for National Fire Protection Association-compliant PPE and other equipment," Kallner points out. "In my area, the portion of annual revenues municipalities allocate to fire departments might cover what it costs to outfit one new firefighter in PPE and provide an air pack and a radio. The rest of the budget? Fundraising."

"Volunteer fire departments need all kinds of help, and it doesn’t all involve training to put on an air pack and enter burning structures. Sometimes it’s helping sell food and beverages or raffle tickets at community events," Kallner adds. "Next time your volunteer fire department hosts an open house, get pictures of the kids or grandkids with the shiny fire trucks, for sure. But also ask, how old is that truck? If you had to replace it, what would that cost? And what would it take to raise that money? Sticker shock about PPE and other equipment pales in comparison to fire apparatus. . . . We also need people brave enough to look at price tags and grant applications squarely, swallow their sticker shock, and say, 'How can I help?'"

Peers can help first responders with mental-health support

First responders work long shifts and routinely see the worst day of someone's life. It's a stressful job, but many don't want to seek help for mental health needs. Peer groups can help, Peter Andrey Smith reports for Undark., which says it is "a digital magazine exploring the intersection of science and society."

First responders don't often seek mental-health support for many reasons. Part of it is shame, but part stems from a more practical concern: "There is also the threat of losing one’s livelihood. Many physicians fear that state boards could suspend their license or revoke its renewal if they seek mental-health care," Smith reports. "The threat of formal sanctions can reinforce a workplace culture that stigmatizes mental health. Seeking treatment may be seen as a career-ending decision — that a person is unfit for duty, both in the eyes of their colleagues and their profession."

Smith tells the story of a former EMT in Colorado who joined a peer support group last year, and how the program has helped him cope. 

The concept of peer support groups for EMTs "has resonated with administrators and staff alike. But sources say that, in part because it is predicated on patients’ trust, and in part because of its ambiguous definition, peer support lags in one key respect: Research on its effectiveness is limited. Proponents also caution that these programs cannot necessarily replace reform that addresses systemic problems plaguing the workforce," Smith reports. "Peer supporters are nonetheless forging ahead. In recent years, the U.S. Health Resources and Services Administration has invested millions in peer support programs. Leading medical organizations and practicing physicians have called for implementation in health care settings, where a staggering number of workers have quit since the pandemic began. All in all, experts are suggesting: Who better to care for caretakers than one of their own?"

Bipartisan bill aims to help struggling rural ambulances services by extending Medicare reimbursement boost

A bipartisan bill aims to help ground ambulance services, especially in rural areas, by making sure they get more generous Medicare reimbursements. Many rural ambulance services are in danger of closing, partly because they serve a disproportionate share of Medicare patients, and Medicare reimbursement rates are often lower than the cost of providing the service. 

Congress authorized add-on payments through 2022, and plans to review Medicare cost data to decide whether the payments should be made permanent. But the coronavirus pandemic has kept the Centers for Medicare and Medicaid Services from doing the first two rounds of data collection. 

The bill would extend those rates for five years. It would also protect ambulances from reimbursement changes tied to census data that, the bill's sponsors say, may not accurately show rural need for emergency services. Each ZIP code's rurality is reassessed after every decennial census; the bill would ensure that rural ZIP codes continue to be classified as such so ambulances can keep getting add-on payments. 

The bill is co-sponsored by Sens. Bill Cassidy (R-La.), Susan Collins (R-Maine), Patrick Leahy (D-Vt.), Catherine Cortez Masto, (D-Nev.), Debbie Stabenow, (D-Mich.), and Bernie Sanders (I-Vt.). Its House counterpart was introduced in early May by Reps. Markwayne Mullin (R-Okla.), Devin Nunes (R-Calif.), Terri Sewell, (D-Ala.), and Peter Welch (D-Vt.).

Pandemic roundup: What happened when people gave up on Spanish flu pandemic measures a century ago

Here's a roundup of recent news about the pandemic and vaccination efforts.

Commentary: people gave up on Spanish flu pandemic measures a century ago when they grew tired of them, and paid the price. Read more here.

Commentary: How to build trust in the coronavirus vaccine among communities of color. Read more here.

In rural Louisiana, officials look for answers to improve lagging vaccination rates. Read more here.

Americans are becoming more confident in the safety of attending in-person religious studies, according to a recent poll. Read more here.

A research group is seeking responses from local government employees to help determine how the pandemic has changed their work. Read more here.

Community leaders in Alabama and Mississippi are trying to shrink the racial disparities in Black residents' access to coronavirus vaccination. Read more here.

Vaccine hesitancy among guards and inmates (as well as other first responders) could threaten state prisons and general public safety. Read more here.

Quick hits: small churches arming themselves; firefighters must adapt to climate change

Here's a roundup of stories with rural resonance; if you do or see similar work that should be shared on The Rural Blog, email us at heather.chapman@uky.edu.

Houses of worship have been increasingly targeted by shooters in recent years. Some churches, too worried to go gun-free, are arming themselves. Read more here.

Wildfires are bigger and more destructive than ever because of climate change. That means firefighters and their communities need to adapt to meet the challenge, writes one firefighter. Read more here.

Texas leads the nation in the number of rural hospitals closing. But the funding cuts to hospitals in President Trump's proposed budget would threaten even more hospitals in Texas (and other states). Read more here.

Beloved Kentucky priest Father John Rausch, a passionate advocate for Appalachians, has died at 75. Read more here.

The American Farm Bureau Foundation hopes to help bridge the rural-urban divide by educating young consumers about agriculture and the role it plays in our lives. Read more here.

A new Veterans Affairs Department initiative aims to fill the shortage of rural medical practitioners. Read more here.

Staffing issues put one-third of rural ambulance services in jeopardy, National Rural Health Association says

A Tri-State ambulance (Image from WEAU-TV)

One-third of rural emergency medical services are so short-staffed that they are in "immediate operational jeopardy," posing risks to rural residents who rely on them as a health-care safety net, says a policy brief from the National Rural Health Association.

"Dwindling population, losses in the volunteer workforce, and decreased reimbursement threaten continued access to these services," says the the brief by Nikki King, Marcus Pigman, Sarah Huling and Brian Hanson.

"One of the largest contributing factors to the disparity in mortality rate from traumas, such as overdose, for rural residents (discussed above) is travel time and distance to trauma centers," they write. "Rural residents are significantly more likely than non-rural residents to die following traumatic injury."

Hayley Spitler of WEAU-TV in Eau Claire, Wis., cited the brief in a story that featured Kent Stein, operations manger of Tri-State Ambulance. "We're experiencing the same thing that companies are experiencing nationwide, both volunteer and professional companies. We sometimes can run into a challenge finding EMTs and medics out of school."

Medicaid rejects Wyoming's request to have Medicaid cover air-ambulance service for all in the sparsely populated state

Government Accountability Office photo

"The Centers for Medicare and Medicaid Services this month rejected a proposal that Wyoming health department officials hoped would allow the state to rein in the high cost of air ambulance service" by having Medicaid cover it for anyone in the state, Andrea Noble reports for Route Fifty.

Rural residents rely disproportionately on air ambulances, especially in Wyoming, the nation's least populous state and, except Alaska, the one with the lowest population density. But many patients are faced with high surprise bills, even those who have private insurance. So, Wyoming health officials asked the CMS for a waiver to treat the industry like a public utility and expand Medicaid coverage to all Wyoming residents for the specific benefit of access to air ambulances, Noble reports.

"In its waiver request, Wyoming estimates that about 4,000 people were taken to the hospital by air ambulance in 2018. Approximately 90 percent of those patients do not have to pay for the cost of transport because of insurance coverage. For the remaining 10% of patients, the average out-of-pocket cost per flight is $2,250. But out-of-pocket costs have reached upwards of $40,000 in a handful of cases, the state said," Noble reports. "The state said that its proposal would have allowed Medicaid to determine statewide requirements for air ambulance coverage, issue competitive bids for providers and establish a centralized call center that would direct air ambulance traffic. The price for transport would likely have been lowered through the competitive bidding process, the state said."

CMS rejected the idea in a Jan. 3 letter, calling it an inappropriate attempt to circumvent federal aviation law, which would be a misuse of Medicaid, and that it would cost too much, Noble reports.

Quick hits: Appalachian Trail mural project; how a Texas town bounced back after losing its Walmart

Here's a roundup of stories with rural resonance; if you do or see similar work that should be shared on The Rural Blog, email us at heather.chapman@uky.edu.

A rural Wisconsin doctor fights to manage patients' opioid use amid the addiction crisis. Read more here.

Proposed bipartisan legislation would expand federal housing aid to rural volunteer firefighters and first responders. Read more here.

An op-ed writer writes about why rural voices must be included in the renewable energy debate. Read more here.

Here's how one small Texas town rebounded after it lost its Walmart. Read more here.

An art project reflects the beauty of nature through murals in towns along the Appalachian Trail. Read more here.

New Indiana map, viewable by public, shows where first responders have given naloxone for opioid overdoses

To help fight the opioid epidemic, Indiana has launched a new interactive mapping tool that shows where first responders have administered naloxone to reverse opioid overdoses, Kate Queram reports gfor Route Fifty. Unlike the ODMap being used by first responders and leaders in 27 states, Indiana's map is viewable by the public.

Screenshot of the interactive map.

The Naloxone Administration Heatmap, announced by the Indiana Commission to Combat Drug Abuse, obscures addresses for privacy, but labels overdose sites within 100 meters in urban areas and 500 meters (about one-third of a mile) in rural areas. Users can toggle the settings to select for overdoses within the past 30 days, within the year to date, or from years dating back to 2014. Other adjustable settings include whether the overdose happened roughly during the day or night, or on a weekday or weekend, Queram reports.

The tool was developed by a partnership between the Indiana Management Performance Hub and the Indiana Department of Homeland Security. Providers send EMS data to the state's homeland security database, which the management performance hub then analyzes and plots on the map.

"Not every naloxone usage is an overdose, according to the commission, but 'preliminary analysis indicates' that approximately 75 percent of administrations of the drug are to treat overdoses," Queram reports. "About 15 percent of 'naloxone incidents' have not been added to the map because the address was poorly formatted or missing, according to the website."

Volunteer firefighter says controlling traffic after a wreck can be scarier than fighting fires, gives tips for motorists

Firefighters and deputies clean off a road after an accident.
(Photo by Donna Kallmer)

Rural areas often depend on volunteer firefighters to battle the blazes spreading over the western and southern U.S. this summer, but that's not all they do. According to Donna Kallner in an essay for The Daily Yonder, she and her fellow rural volunteer firefighters also play a vital part in helping EMTs, sheriff's departments and professional firefighters respond to car wrecks. That includes not just cleaning up the roadway afterward so it's safe for traffic, but sometimes controlling traffic. That can be scarier than fighting a fire:

"Traffic control takes grit, whether you’re a Good Samaritan with an angel on your shoulder or a trained volunteer. Believe me, it’s scary out there. Folks who are good about pulling over for emergency vehicles running with lights and sirens can’t resist taking a quick peek as they drive past the scene of a wreck. They want to see what happened, what’s happening now, if anyone they know is involved. It’s human nature. But it’s scary to be on an accident scene trying to do your job when motorists are moving through with their heads on full swivel," Kallner writes. "It’s even scarier to be the person holding a sign on a pole a quarter mile away trying to stop traffic before it reaches a scene. You’d be surprised how many people don’t seem to notice the flashing lights, the high-visibility gear, or the person holding the sign who looks like he’s ready to dive for the ditch — which he is."

Kallner wants readers to keep three things in mind if they approach a roadside emergency, for the safety of first responders and drivers: First: there's often very little room to maneuver past a wreck on a country road, so drive carefully and watch for first responders and their vehicles. Second: resist the urge to rubberneck and pay attention to first responders' signs and directions to avoid getting into a secondary accident. Third: remember that the scene of a wreck is very loud, what with idling diesel trucks, sirens, and radios, so don't assume a first responder can hear your vehicle approaching.

"As a passing motorist, you have an important role on the scene," Kallner writes. "We need you to watch out for any and all unexpected movement, and be prepared to stop on a dime or move along briskly if you’re waved at to do so. We’re counting on you. And if you happen to be stopped by traffic control on a hot day and you happen to have a cold bottle of water or Gatorade handy, pass one out the window to the person doing the scariest and most thankless job. They like cookies, too."

Concert Saturday in Annapolis will benefit the Capital Gazette Fund and first repsonders

Harvey aid bill also helps agencies fund wildfire fighting

A helicopter with a water bucket battles
a blaze near Stevenson, Wash. (Associated
Press photo by Randy Rasmussen)

Weary Westerners have complained that the public has largely ignored the wildfires that are decimating the region, but their lawmakers are listening. "A bipartisan group of 12 senators from western states sent a letter this week to Senate Majority Leader Mitch McConnell and Minority Leader Chuck Schumer, urging that the wildfire provisions be included in the bill with the hurricane recovery funding," Bill Lucia reports for Route Fifty. 

The legislation was needed because of an issue known as "fire borrowing." Normally, when a federal agency uses up the money budgeted for firefighting, it must borrow money from other accounts, some dedicated to wildfire prevention. The appropriations bill passed in May provided $4.2 billion for wildland firefighting and prevention programs, but costs for fighting this year's fires are estimated to cost $300 million more than that. The senators asked that the borrowed funds be replenished promptly when the new fiscal year begins in October so that those agencies will not face long-term budget shortfalls. President Trump signed the bill on Sept. 6.

This year has been the worst wildfire season in years. Wildfires have burned across about 8 million acres of the U.S. this year, mostly in Western states. "That total exceeds the average number of acres burned annually during the prior decade, which is 5,558,384. As of Saturday, there were 67 large, active fires, affecting roughly 1.6 million acres," Lucia reports.

Rural fire departments struggle to fill aging ranks, deploy new recruiting strategies for volunteers

Russel Prince volunteered for 50 years
in Winside, Neb. (World-Herald photo)

Small-town and rural fire departments are short on volunteers and struggling to keep the ranks full. Populations in most small towns are aging, "and that’s reflected in those who serve some of the most important public safety chores: fighting fires and answering rescue calls, from highway accidents to heart attacks and slips and falls," reports Paul Hammel of the Omaha World-Herald.

Nationally, about 31 percent of firefighters in towns under 2,500 in population are 50 or older, and probably older the the smallest towns, officials told Hammel. The average age in most rural counties is rising. "About half of Nebraska’s 93 counties had median ages of 45 and above in 2010, compared with only two counties in 2000," Hammel reports.

Officials told Hammel that demands of children, school and family make it difficult to persuade young people to volunteer, and population decline makes it harder to find volunteers. “The fact is we have an aging workforce and we don’t have that rush into the fire service,”  Michael Dwyer, secretary-treasurer of the Nebraska State Volunteer Firefighters Association, told Hammel.

Small-town departments in Nebraska and Iowa have used several strategies to help fill the ranks, such as recruiting high-school-age "cadets" as helpers and reimbursing training costs and paying a small stipend to answer calls, Hammel reports. "As an incentive to volunteer, the Nebraska Legislature passed a law this year granting a $250-a-year income-tax credit for those who volunteer for fire and ambulance services. In Iowa, a similar law went into effect in 2013."

The main example in Hammel's story is Winside Fire and Rescue, in a town of 427 with 34 volunteers, and former member Russel Prince, 79, one of five volunteer firefighters in Nebraska honored this year for 50 years of service. "He quit taking rescue calls three decades ago due to the time-consuming training required and, because of his age, cut back his role on fire calls in recent years mostly to driving pumper trucks and helping with equipment," Hammel reports.

“I told them if they needed help to holler,” said Prince, who retired in October after staying a few months to reach the 50-year milestone. Prince told Hammel he remembers when volunteers wore raincoats to fires, not the fire-protective bunker gear now used. He recalls when the Winside department got its first ambulance in 1974 -- a federal surplus 1964 Ford station wagon.

"The numbers of volunteer firefighters in both Nebraska and Iowa have slowly dwindled over recent decades, and with rural populations projected to continue to fall, it’s prompting concern," Hammel reports. "In Nebraska, an estimated 12,000 volunteers answer fire and rescue calls over 72 percent of the state, from suburbs like Gretna and Waverly to rural areas like Winside."

A woman dies because a rural county skimps on its ambulance service; weekly digs deep, points way

The need for better emergency services in rural areas is illustrated in the tragic story of Rita Sue Jenkins. The Western Kentucky woman lived just four miles from an ambulance station in the small county seat of Elkton. But when her family called 911 on March 24, it took the ambulance 43 minutes to get there. She never made it to the hospital, dying five minutes later in her home, reports Tonya Grace of the Todd County Standard, a weekly paper that has earned the title of best small newspaper in the state for seven straight years.

The problem, which is one that many rural areas face, is a lack of services. Todd County only has two ambulance crews. One was at a call in a neighboring county because that county's services were already occupied, and the other was sent out to another call that came within minutes of the call for Jenkins, Grace writes. That meant that despite Jenkins' close proximity to the ambulance station (a relative said it took him four minutes to drive there) the ambulance that responded to her call came from another county.

Jim Duke, owner of the Todd County service, told Grace that anytime two calls are received at the same time, dispatch personnel and the ambulance crew decide which is worse and respond to that one, arranging for another crew to get the second one. Since the other caller reported a cardiac arrest, and Jenkins' family reported weakness and someone sick, the other call got top priority.

Since the incident, suggestions have been made to improve service, such as having one truck on duty all the time with a paramedic and emergency medical technician, and the other to have two trucks, a 24-hour and a floater crew truck on duty for 12 hours during the day, with an crew on call the other 12 hours, Grace writes. One ambulance is staffed 24 hours a day and another one floats between Todd County and adjoining Logan County. Todd County can't afford two full-time ambulances, Judge-Executive Daryl Greenfield told Grace. In her long, richly detailed story, she notes that the service, whose contract is up for renewal, has been "criticized for not hiring local people who would be familiar with the local community, its roads and neighborhoods."

But if rural residents in places like Todd County want better services, they're going to have to pay for it, writes Ryan Craig, editor and publisher of the Standard. "What we see as the real issue is the funding of, not only this service, but other services in the county," Craig opines in a front-page column. "For too long we have kept our funding levels about the same while other counties around us have upped their level of services through smart funding."

Craig concludes: "It is time we no longer condemn and threaten to run off our local officials at even the mention of higher taxes, especially if it is to improve our lives. As the old sayings go, we are at the nub, and all the blood is out of the turnip. The family of Rita Jenkins told the Standard that they don't want something like this to happen again. I couldn't agree more. It is time we became serious about our services. We owe that to Rita Jenkins and her family."

To read both articles click here.

Nebraska gets $5.3 million to update rural ambulances to better serve heart-attack victims

Nebraska is investing in saving the lives of rural heart-attack victims. The Midwest Affiliate of the American Heart Association announced Tuesday a $5.3 million initiative called Mission: Lifeline that "will update the equipment in rural ambulances to help emergency responders better identify and triage a severe type of heart attack known as ST-elevated myocardial infarction," Shelby Fleig reports for the Omaha World-Herald. "The hope is that by identifying this type of heart attack more quickly, patients can be taken to the nearest medical facility ready to perform a coronary angioplasty, the ideal treatment for this kind of attack, the association said."

Tom Appleget, director of invasive cardiology at Denver-based Catholic Health Initiatives, told Fleig, “Some of these volunteer squads can’t afford some of the systems. This allows them to own the equipment and transmit the EKG to a physician from the field and bypass a hospital that doesn’t have a (catheterization) lab.” (Read more)

Every year 5,000 Nebraskans die of heart failure, reports KETV in Omaha. The new equipment is available in most urban areas and some rural ones, such as Beatrice, a town of 12,000 located in the southeastern corner. Already in Beatrice, the equipment has helped save three lives, said Fire Chief Brian Daake. Michael Schnieders, CEO of Good Samaritan Hospital in Kearney, told KETV, “This is a great for rural health care in Nebraska, especially for heart patients, their love ones and their family members." (Read more)

Rural Minnesota struggles to replace retiring volunteer medical responders

The number of volunteer first responders in rural Minnesota is hitting dangerously low levels, with retirement brutalizing a service that relies on younger generations to step in to fill the growing need. The problem is that with younger generations moving to urban areas, there's no one to fill that need, Pam Louwagie reports for the Minneapolis Star Tribune. In rural northwest, southwest and west central Minnesota, 17 to 18.5 percent of residents are 65 or older, with numbers expected to grow to 21 percent by 2020, and 26 percent by 2030. (Strib photo by Renee Jones: Jamie Sommers of Wanamingo in EMS training)

About 60 percent of the state's rural emergency responders are volunteer, but "The shortage of recruits has shuttered some small emergency squads, lengthening response times as ambulances race to help from farther away," Louwagie writes. "Emergency service leaders say the problem will only get worse and they will have to get creative with solutions, likely by mixing in some paid staff and figuring out a way to pay for them." Mark Schoenbaum, who directs the state health department’s Office of Rural Health and Primary Care, told Louwagie, “I think we stand at a critical point. Given (baby boomers’) predominance in the rural EMS volunteer workforce, in 10 years few of them will still be on the scene.”

With ambulances sometimes 45 to 50 minutes away, rural Minnesota relies on volunteer first responders when it's a life or death situation. Joe Mercil, who recently retired as a volunteer in Brooks, a town with a population of 141, said finding a replacement was tough. He told Louwagie, "I decided it was time for me to quit and let the younger people take over, but you can’t get anybody in these towns to take over. … The first question they ask is ‘How much money do you make?’ They don’t realize you’re (a) volunteer.” And being a volunteer means that in addition to working a full-time job, or having other full-time duties, the first responder has to remain earshot of an emergency radio, because they might be the only one in town qualified to help. (Read more)

Maine has statewide program for emergency workers to train residents about preventive health care

Maine's emergency workers are using time between emergency calls to educate state residents about health and preventative health care "as part of a statewide effort to reduce hospital and doctor visits for emergencies," Kaitlin Schroeder reports for the Morning Sentinel in Waterville, 56 miles southwest of Bangor. "The NorthStar Ambulance house call program, which will start next month, is part of a state initiative to redefine paramedics and emergency medical technicians as not only emergency responders but also medical emergency preventers." The program is one of nine state pilot programs, and expenses for most programs will only consist of fuel for travel. (Daily Bulldog photo)

Maine, which has the highest percentage of rural population in the country, "has been developing the project for the past decade to use the long waiting periods that rural emergency service workers sometimes sit through while waiting for a call," according to Jay Bradshaw, director of Maine Emergency Medical Services, Schroeder writes. Bradshaw told Schroeder, “In some places they might get a call or two a day, but there still needs to be paramedics there 24 hours a day.” While other states have similar programs, "Bradshaw said Maine will be the first state to have not just individual paramedic projects, but a coordinated state effort." Schroeder writes.

"The workers also will help patients list and compare all the medicines they are taking and make sure the combination won’t cause unwanted reactions from mixing prescription drugs," Schroeder writes. "The paramedics will offer other services such as checking vital signs, wound care, hypertension monitoring, diabetes management, ear and nose complaints, flu vaccinations and potential fall assessments. Primary-care doctors will refer patients to the program. Those patients generally will be people who are newly released from the hospital, have had a recent surgery, have multiple chronic conditions or live in a home where safety is a concern." (Read more)