CENTERVILLE — The Centerville City Administrator hopes the legislature will take notice of the role rural emergency medical services are playing in the COVID-19 pandemic and make it an essential service.
In Iowa, ambulance service is not listed among “essential services” that counties must provide to their citizens. Iowa code requires that fire protection and law enforcement be provided, but not ambulances.
It’s been a political discussion for decades with the Iowa Legislature, but state lawmakers have stalled making the designation. Declaring a service to be essential translates to requiring that said service is funded.
Nervousness over creating a new funding stream for each county to provide funding for an ambulance service.
Jason Fraser, the Centerville City Administrator, said during Monday’s city council meeting that systemic changes are needed.
“EMS is a very essential service,” Fraser said. “And this is testing that completely, and I hope that …. the legislature sees that coming out of all this, of how critical it is and how our system for EMS is not set up to respond to this currently. We need to push to make some systematic changes to make EMS better.”
The EMS debate is not a new topic for Centerville and Appanoose County. In 2018, they decided to deny a private company’s request for a taxpayer subsidy and instead created their own government-run service within the Centerville Fire Department.
Responding to 911 calls in an ambulance is not a profitable venture. The private company that requested a subsidy in 2018 reported it had lost $170,000 responding to emergency ambulance calls in Appanoose County.
In August, Fraser said the city-run service, which responds to ambulance calls for most of Appanoose County, was about $200,000 in the red for its first full year. However, that’s cheaper than the $250,000 demand the private ambulance company had requested in 2018.
The city was able to use other funds to make up the deficit without raising property taxes. They are also looking into programs like GEMT — Ground Emergency Medical Transportation program — to help fill in the gaps caused by low reimbursement rates from Medicare and Medicaid.
Fraser said the city had seen an uptick in the number of employees out for quarantine, but he wasn’t aware of any employees currently positive with the virus as of Monday.
Councilmember Jay Dillard asked whether the city has surveillance testing, particularly for the city’s ambulance, fire and police staff.
The answer was no, Fraser said, citing a lack of resources. Employees get tested if they are symptomatic with exposure (or they can get a test through Test Iowa, much like a citizen would, for no charge).
However, Fraser pointed to state guidance for essential employees, which states that even those who have tested positive can still work if they are not symptomatic, even though those infected can spread the coronavirus even if they don’t have symptoms.
“… even if they tested positive, they would still be expected to work unless they were symptomatic. And that’s the standard for EMS,” Fraser said. “And that’s where I get to the point that … our system is broken and they will have to work as long as they are not sick. And that is the guidance put out.”
Dillard said he was not comfortable with those guidelines but pushed for systemic testing provided by the city for its employees.
“Any employee that feels they need to have a test, we’ll get a test,” Fraser said. “I understand your systemic testing you’re talking about and how difference facilities are able to do it once a week … but that’s not something that’s really been extended to public safety realm, just because they don’t have a person to replace them even if they are sick.”