Rural providers, paramedics and county officials tell committee grants and staffing rules leave small ambulance services vulnerable

Local providers, paramedics and elected officials urged the Emergency Response Services Committee to dig deeper into how state grants are awarded, how local taxing districts are used to support ambulances, and whether existing benefit programs provide adequate protection to volunteers. Testimony spanned the state and included examples from Oaks, L'Amour, Carrington, Bowman, and McVille.

Common themes: witnesses said state assistance grants and the formula used to distribute them are difficult for small services to navigate, that administrative requirements sometimes disadvantage small volunteer services, and that large hospital-owned or private services sometimes receive aid while smaller volunteer services do not. Several speakers asked the state to standardize and simplify grant application processes and to improve communication when applications are incomplete.

Local funding and tax districts: multiple witnesses said forming an ambulance tax district and levying a mill rate offered a reliable revenue source for some services, but many districts still lack the revenue needed to staff 24/7 coverage. Macville Ambulance Service Chairman Mark Reinhardt told the committee that his district adopted a tax levy this year and raised the rate after voters approved additional mills, but he said even with the levy the average cost per call in 2024 was about $2,582 while average reimbursements were about $854 — a shortfall he described as unsustainable. Several witnesses said county commissioners and local elected officials will need to weigh whether to increase tax support or pursue alternative models.

State assistance and grants: paramedic and small-service testimony said the legislation has not fixed longstanding administrative hurdles. Mike Sandy, a paramedic who manages Oaks Ambulance, and other small-service managers said applications can be held up by simple documentation requests, and that state staff sometimes struggle to reach local contact addresses. Sandy told the committee the state assistance grant has been helpful but that the application and allocation process has not reliably favored the smallest services.

Workforce and industry impacts: Dickey County Sheriff Chris Estes and others described how a major private construction presence (the applied-digital campus) has dramatically increased temporary workforce and housing demand in a small town, worsening housing and labor shortages for volunteer recruitment and for critical county jobs. Several witnesses said employers may be reluctant to release staff for training or response in some industries, and asked the committee to consider incentives for employers who allow employees to respond to emergencies.

Training, benefits and WSI: witnesses urged the committee to gather specific numbers on who is being covered for workers' compensation and death benefits, and to compare the cost of workforce-safety coverage with the state's current lump-sum death benefit. Representatives suggested the committee examine whether volunteers could buy into the public safety retirement plan or a length-of-service award program.

Why it matters: witnesses said the combined effect of low reimbursement, onerous administrative burdens on small services, and competition for labor threatens coverage in some rural areas. Several services said they had to rely on private staffing firms to cover shifts. Committee members directed staff to collect more granular financial data and deploy a provider survey to yield consistent statewide evidence for policy options.

Selected quotes: "We must maintain local small-town ambulances because the people volunteering for these services are vested in these communities," paramedic Mike Sandy said. "When you bring in a contract service, you lose a lot of that compassionate care."

Next steps: the committee approved a consultant-led survey and asked staff to collect data on grant allocations, mill levies, and service closures to inform the consultant's work.