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Our View: Credit Carlton on ambulance issue

It’s no secret rural ambulance services are struggling. Called a “quiet crisis” by the state health department as far back as 2002, rural ambulance services across the state are being confronted with their own mortality: Continue forward in the face of endless budget deficits, or fold, and let neighboring or private ambulance services take over, sometimes coming from much farther away.

It all makes what the city of Carlton has accomplished so impressive.

Instead of waiting for legislative solutions, city officials and leaders in Carlton spent the past two years doing the hard work of analyzing the issue, presenting their findings to surrounding municipalities, and gaining consensus that helped bolster the service.

“I imagine we’ll be getting several phone calls and sharing our story to other services, too,” Carlton fire chief Derek Wolf told the Pine Knot.

“It all starts locally,” he added.

The city is in the process of hiring two full-timers to a service that had been fully staffed by paid, on-call personnel. Those new full-timers, including the new ambulance manager featured in this issue of the Pine Knot, will work the ambulance during the hardest shifts to fill with on-call staffers — daytime shifts Monday through Friday. Additionally, the manager will conduct the scheduling and administer the service in ways which are expected to yield grants and other financial benefits.

In order to make it happen, municipalities in the service area had to be convinced to raise their voluntary contributions to the service. In addition to the city of Carlton, the townships of Atkinson, Blackhoof, Mahtowa, Sawyer, Silver Brook, Thomson, Twin Lakes and Wrenshall all ultimately agreed that the local ambulance service was worth the investment.

Only the city of Wrenshall and Black Bear Casino Resort declined to help fund the service, despite both being served by it.

In some cases those contributions seem modest, in others substantial. Twin Lakes Township is paying $76,000 in 2024, Mahtowa Township only $5,001. A municipality’s contribution is based on a formula devised by a committee Carlton created that includes all financially contributing service area members. The formula averages two years of net tax capacity and three years of ambulance call volumes to prorate a municipality’s contribution.

Regardless of financial contributions, the city of Carlton’s ambulance service is required by state law to serve communities within its designated service area.

Throughout the past two years, Carlton leaders have declined the idea of giving up and looking elsewhere for ambulance service, repeatedly saying they wanted to be the ones helping their residents and neighbors.

And they made it happen in the face of mounting obstacles:

• Numbers of ambulance workers are down at a time call volumes appear to be rising everywhere.

• Medicare, Medicaid and commercial insurance companies pay only portions of what’s billed, so when a service gets 40 percent of the cost of a call recouped, that’s a win.

• Services are required to train personnel and provide their own equipment, including ambulances, which can cost more than $200,000.

Already this year, there have been more than a handful of bills introduced in the state legislature aimed at buoying rural ambulance services. Additionally, there are roughly two dozen bills that could be revived from the previous legislative session. But it’s taken more than 20 years of warnings to get to this point.

And while the possibility of doing away with budgetary constraints is attractive, the alternative of letting outside or private ambulance services fill the void is not appealing for rural areas. Response times soar as residents in need wait for services emanating from the nearest metropolitan area.

It’s a problem without an easy solution.

But at a time when others are throwing up their hands and even throwing out their service, the city of Carlton bet on itself and its neighbors. City leaders put in the work and convinced surrounding decision-makers to believe in a new way to conduct the service. The result is the sort of effort and outcome of which we can all be proud. Lives will be made better, even saved, by the efforts of Carlton’s leadership.

So, thank you Carlton, for showing us how we can own our problems and create our own solutions.