The system in northern St. Louis County is broken.”

Allen Lewis

TOWER— Virginia Fire Chief Allen Lewis offered a closer look at operations, finances, and the demand for emergency medical services (EMS) across northern St. Louis County during a presentation at the Tower Civic Center last Wednesday.
The Tower City Council had invited Lewis to present data he has developed and to talk about new approaches to providing emergency medical services in the Tower-Lake Vermilion area in particular.
Lewis did not offer a proposal, but he did suggest that change would be needed soon in order to ensure that patients will have prompt and well-trained responders in the future.
“The system in northern St. Louis County is broken,” said Lewis. “I hear it everyday. You’re lucky here in Tower because you’ve got a good group of people who aren’t missing calls. But other services [that are missing calls today] were in that same place not that long ago.”
Lewis’s presentation comes at a time of questions about the future direction of the Tower Area Ambulance Service. The city of Tower, which operates the TAAS, has also been seeking to renew an ambulance subsidy contract with area townships, but has been facing pushback from township officials who have wanted more financial information than the city has been able to provide to date.
TAAS director Steve Altenburg is also attempting to advance a part-time advanced life support (ALS) system, although the costs and benefits of that approach aren’t yet clear. Lewis noted that a shift to ALS would generate a modest amount of additional revenue, depending on how frequently the ALS service was needed. What remains unclear is how the TAAS could afford to train and maintain paramedics on staff.
Breitung Board Chair Tim Tomsich questioned the financial viability of ALS. “We’d be losing more money under ALS,” said Tomsich. “Despite the need, there’s still a financial equation that doesn’t add up.”
Lewis said such decisions can’t always come down to money and that patient care has to be part of the equation. Altenburg agreed. “ALS is not about making more money,” he said. “What it would provide, is a higher level of care faster. It won’t generate tons of extra revenue, but as long as it doesn’t cost us money.”
Whether implementing ALS service could be implemented without impacting TAAS financially remains unclear. While Altenburg has been pursuing a part-time ALS service for several months, he has yet to provide the council with an actual proposal that includes projected revenues or the anticipated expenses of training and then paying paramedics and providing any additional equipment required for ALS-level care.
David Rogers, with the Minnesota Emergency Medical Services Regulatory Board, who attended the presentation, suggested that it would be a challenge for the TAAS to find and keep paramedics. He noted that EMS services around the state are struggling to maintain qualified staff. He said even Hennepin County’s EMS service has 50 unfilled paramedic positions, highlighting the existing shortage.
Lewis, when interviewed after his presentation, said it will be a challenge for any area service to maintain paramedics unless they have full-time wages and benefits to offer. The approximate base cost of a full-time paramedic in Virginia, including benefits, is just over $100,000 according to Lewis.
And Lewis said none of the area ambulance services should be basing staffing or level of care decisions with the expectation that they can use non-emergency transfers to pay the cost. He said Virginia is continuing with its plans to ramp up its capacity to handle an increasing share of the transfer demand coming out of the Essentia system in Virginia. The Virginia EMS has right of first refusal for all of those transfers.
Lewis said either Virginia or Ely is currently providing ALS service to the Tower-Soudan area when it’s needed, which is about 15 percent of the time. He said Virginia provides ALS level care in about 65 percent of the runs that it handles in its coverage area, although he said much of that is provided for the convenience and comfort of the patient rather than medical necessity.
Lewis noted that emergency calls for ALS service in the TAAS service territory show no discernible pattern in terms of time of day. That could make it difficult to determine an appropriate staffing pattern for a part-time ALS service. Lewis suggested more coordination with neighboring ALS services could be part of a solution, and he predicted that some consolidation of services may be in the offing. “We will probably see a regional approach,” he said. “Like school consolidation, you’re stronger when you work together.”
Whether consolidation is the answer to the ongoing shortage of available staff is less certain.
Like most area services, the TAAS has struggled at times to maintain the staffing for its basic life support (BLS) service, much less a possible ALS service.
“It’s a problem that’s not unique to St. Louis County,” said Fourth District Commissioner Paul McDonald, who noted that as the older generation of emergency responders retire, there are fewer young people to take their place. “We need to have some kind of an incentive system to entice young people,” he said. “We’re at a stage now, where sooner or later will hit every one of us.” McDonald said the county board is aware of the problem and is discussing ways that the county could do more to assist EMS services in the county.
While the outline of a regional approach to EMS in the region remains in the formative stage, county commissioners are actively talking about how to provide a more reliable and broad-based funding stream to implement a regional system of EMS, including both fire and medical services. “The other commissioners outside of Duluth are very aware of this problem,” said McDonald. “It is definitely on our radar. We’ve got to find a carrot out there somewhere to get that generation to come in and take over.”

TAAS by the numbers
Lewis provided an abundance of data on the TAAS, including information that some township officials have sought previously. Lewis noted that TAAS put approximately 43,000 miles on its three ambulances combined in the past year, with 28,507 (or two-thirds) of those miles for non-emergency transports between regional hospitals. Some township officials have been critical of the increased number of transfers, due to the extra wear and tear on ambulances, which Altenburg has not factored into the financial calculations on the paid staffing model he introduced in 2017.
While the average transfer involves 245 miles of driving for a TAAS ambulance, the reimbursement rate is also significantly higher. According to Lewis, the TAAS receives $1,468 for a typical transfer, compared to $609 for an average emergency medical call. The TAAS has accepted more transfers than in the past since switching to paid staffing, which has boosted revenue, but the service’s expenditures have nearly doubled in less than two years, which has reduced operating margins for the TAAS.
Lewis did note that the switch to paid staffing has shortened response times. “That’s not rocket science,” said Lewis. “That seems pretty obvious.” Based on his analysis, the switch to paid staffing has cut the average response time for calls outside of the Tower city limits from 16 minutes, 45 seconds to 14 minutes, 50 seconds and from six minutes, six seconds to three minutes, 37 seconds within the city.
Lewis also highlighted the hot spots for ambulance calls. The most calls, (66 in the past year) originate at Fortune Bay Resort Casino, while the Bois Forte Health Clinic, Vermilion Senior Living, and the Scenic Rivers Health Services are also frequent destinations for ambulance calls. Including the reservation calls, Greenwood Township accounted for 46 percent of the call volume for TAAS in the past year. The city of Tower accounted for 28 percent, Breitung Township comprised ten percent, with Eagles Nest accounting for eight percent, Vermilion Lake six percent and Embarrass two percent.