MICHIGAN, N.D. — As the coordinator of two small-town ambulance services, Sarah Vaith responds to hundreds of calls for help each year. She hopes her own call for help will be answered.

"We are in major need of EMTs," Vaith said. "And as far as drivers, we can always use more drivers."

The calls vary for a small-town ambulance service. Vaith, Michigan Area Ambulance Service operations manager and McVille Community Ambulance squad leader, deals with geriatric patients who have broken a hip, as well as victims of serious motor-vehicle accidents.

Some are minor. Some are tragic.

The nature of those calls and the sheer volume of the work are among the reasons Jason Flom, the former Michigan Area Ambulance Service operations manager, resigned three months ago.

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Responding to people with severe trauma takes its toll, Flom said, and that may be why there is a growing shortage of people willing to drop everything and be there for neighbors — and others — in need.

“In the last few years, I had bad calls,” Flom said. “Ninety-eight percent of the people in the back seat of the ambulance, I knew them.”

Recruiting volunteers, especially in rural North Dakota and Minnesota communities, is a perennial challenge.

Demand for emergency medical technicians exceeds supply across North Dakota. There are 2,024 EMTs in the state, said Kerry Kirkava, North Dakota EMS coordinator. The division doesn’t track historic EMT numbers, but she said the number definitely is down.

And while there is not a definite target number declared by the state, the consensus is that more volunteers are needed, said Chris Price, North Dakota Emergency Medical Systems Division director. Respondents who participated in a recent North Dakota Emergency Medical Services Association survey listed staffing as their top concern.

Yet the challenge with recruiting is twofold: EMS personnel often commit to long hours responding to potentially tragic medical emergencies of people they likely know. In addition, the pay — if there is any pay — is minimal.

In addition to the 2,024 EMTs, North Dakota has 92 advanced EMTs and 646 licensed paramedics. The state also has 2,179 emergency responders — people who can answer a call but are not qualified to transfer patients. The number of EMRs, especially in rural areas, has increased, possibly because being an EMR doesn’t require being on a call schedule or attending as many classes. But even with the statewide increase in EMRs, some communities are still lacking.

“We are in desperate need of EMRs,” said Betty Pelletier, a longtime member of the Pembina Ambulance Service.

"That's not unique to North Dakota. That's what my colleagues in rural states around me are facing," Price said.

The exact number of additional EMS workers needed in North Dakota is difficult to quantify, said Price, because each ambulance service has different types of calls and locations to cover. The staffing needs of an ambulance service in Fargo-Moorhead are different than those in a small town like Michigan, Price noted.

An acute problem

The problem is acute in some small towns. For instance, finding volunteers in the Michigan area has been especially difficult. The core group of 11 people who worked for the Michigan Area Ambulance Service wasn’t enough to meet the demands of the program, Flom said.

“There are no guarantees of what kind of calls and how many calls you’re going to get,” said Vaith. “We see some really nasty things at times, and you have to be able to do it.”

Flom, an EMT for 25 years, began volunteering in 1991 when he was a senior in high school. In 2012, Flom agreed to fill in for a short time while the Michigan Area Ambulance Service looked for a full-time operations manager.

“I told them I would take it for a year. That year turned out to be until March 31 of this year,” Flom said.

Emergency Medical Services rules stipulate that every ambulance have a call schedule covering 24 hours of the day, seven days a week, 365 days a year. It must be staffed with, at a minimum, a driver and an emergency medical technician.

Not covering the call schedule can put people’s lives at further risk.

“Our population is declining and ambulance isn’t for everybody. As we dwindled and weren’t getting the people we needed, I was carrying 500 hours of calls monthly,” Flom said.

Public meetings were held and ads were published in local newspapers, but it was futile. Flom couldn’t convince people to volunteer for the ambulance squad, he said.

“There were so many who said ‘We couldn’t do that.’”

Neither Flom nor Vaith assign blame, though. It’s just not for everybody.

“Emergency Medical Service people sometimes are of a different breed, for lack of a better term,” Flom said.

“EMS,” Vaith says, “takes a special person.”

But they do exist.

Besides the stress of trying to recruit volunteers, Flom was the scheduler, bookkeeper and trainer for the Michigan ambulance service.

“It came to the point I wasn’t getting the time off I needed,” Flom said. “It was hard to get off during the week to get to doctor’s appointments. When you can’t even get out of town, it becomes hard.”

As a former president of the North Dakota Emergency Medical Association, Flom doesn’t believe the issues he faced as Michigan Area Ambulance Service operations are unique.

“When you go to state meetings, you hear the same thing,” he said. “In any small town across North Dakota, this could play out.”