The Haines Volunteer Fire Department has seen an increase in ambulance calls in recent years, a trend consistent with communities throughout the region. Call increase is one of a number of challenges facing volunteer-based departments.
“Our call volume has been steadily increasing each year,” fire chief Al Giddings said. “Sometimes, I sit up at night thinking, how come there’s been such an increase in calls?”
As of May 14, the department had responded to 164 calls, putting it on track for roughly 450 for the year, a record-setting number, according to Giddings.
“A big year several years ago was 210 to 230 emergency calls,” he said. Five years ago, the department responded to 323 EMS calls in a single year. In 2019, it responded to 411.
Haines isn’t the only department that’s seen a rise in Emergency Medical Services (EMS) calls.
In Sitka, the EMS department responded to 975 calls in 2011. By 2019, the annual call number reached 1,383, according to Sitka EMS director Rob Janik.
“Over the past decade, all departments (in the state) have seen an increase in calls, although some communities haven’t had as much of an increase as others,” said state EMS officer Todd McDowell, who oversees licensing and training for ambulance services.
Although EMS officials agree that call numbers are rising, what’s causing the increase is harder to say and likely varies from community to community. Population growth and an aging population are two known factors.
Giddings said he thinks the national aging trend is likely impacting Haines’ call volume. Haines routinely ranks as one of the towns in Alaska with the oldest average age.
“We have an aging population here. Our median age is over 50. I think it’s safe to say that with an aging population comes greater medical needs. It’s definitely a contributing factor,” he said.
While some towns have seen call numbers level out in the past few years, for others, especially Southeast towns that have experienced a surge in cruise ship visitors, call numbers have continued to climb, according to McDowell.
“There are some solid indicators that as tourism has increased, call volume has as well. It’s a function of the more people you have, the more potential you have for EMS calls,” he said.
Other potential factors EMS officials listed include the opioid epidemic, economic recession and changing habits in EMS use. McDowell said he thinks people may be calling for ambulances for more routine medical needs, as opposed to severe emergencies. Evidence, however, is only anecdotal, he said.
For most EMS departments, 2020 was an anomaly in the rising call trend. In Haines, the department responded to 11 fewer EMS calls than in 2019. In Sitka, the number dropped by more than 100.
“A lot of departments this last year have seen a drop, a pretty significant decrease due to COVID-19—lack of tourism, people are staying home more,” McDowell said. “One department (in a cruise ship-dependent town) that typically responds to 450 calls a year, responded to 75 last year.”
In Haines, the dip in calls was offset by an increase in the response time involved in each call.
“The intensity is so much more demanding on volunteers. With COVID-19, the decontamination process has way more steps. It could add one and a half to two hours on top of the run,” Giddings said.
Reporting requirements have also increased. Approximately two years ago, the Haines department switched to more detailed digital reporting, Giddings said. Now volunteers spend hours filling out reports for the calls they go on.
This year, with the high number of calls, the department has fallen behind on reporting. On May 14, Giddings said he was filling out a report from May 3.
At the same time call volume and call duration are increasing, volunteer-based ambulance departments are facing recruitment challenges, a nationwide trend. Most fire departments in Southeast Alaska, with the exception of Juneau and Ketchikan, are staffed primarily by volunteers.
“There’s a lot of departments throughout the state that rely on volunteers, and volunteerism is on the decline,” McDowell said. “Years ago, there was more of a sense of public duty. Now, people have kids and school and all these other responsibilities, and the requirements to be an EMT have gone up. You take all of those factors together, and it puts a lot of pressure on someone willing to devote all that time to training.”
Giddings said the same holds true in Haines.
“(Volunteering) is a huge time commitment. We have people in the department with two jobs, trying to grab things on the side to get through the month,” he said. “I’ve had people come in and say as much as they love the department, they’re not able to give the time to be an effective responder.”
The COVID-19 pandemic has exacerbated the problem. In a February interview, Giddings said the department had lost ambulance volunteers who didn’t want to risk exposing themselves to the virus.
“You can’t blame people for not wanting to put themselves at risk of potentially contracting a deadly illness with no compensation. (In Sitka) we had volunteers we had to quarantine for two weeks because of a COVID-19 scare, and they couldn’t go to work. That’s a pretty big ask of a volunteer,” Janik said.
The Haines Borough is again talking about charging a fee per ambulance call. At present, the service is funded through a half-percent sales tax, but sales tax revenues have been down since COVID-19 shut down Haines’ tourism economy.
Borough officials say there’s not a timeline for the discussion, and it would take several years to implement fees if the borough goes that route.
Although many Southeast towns charge a fee per call, ambulance billing in rural Alaska is complicated by the fact that the journey to a hospital often has multiple legs. Insurance usually won’t reimburse for all of them.
The struggle of running a volunteer-based EMS service in rural Alaska isn’t new, according to McDowell.
“It seems like every year, there’s at least one department on the verge of shutting down,” he said. It’s hard, especially for departments with low call volumes—on the order of 50-100—to support the service.
McDowell said usually, when a department in Alaska appears on the verge of collapse, that’s when the community steps up. “If it’s a volunteer issue, people step up. If it’s a funding issue, the community comes together,” he said.
Unlike public education, EMS isn’t a mandatory service under state law. It’s something communities choose to provide. McDowell said it’s up to each community to determine the level of EMS response they want and are able to support.
He said the state is currently conducting an assessment to gauge what’s working well and what needs improvement. Consulting company SafeTech Solutions, which has done similar work in other rural states, is conducting the assessment. The report, including a set of recommendations, is expected in late summer or early fall.