Picture it 1953 in Estherville, IA. A growing city in Northwest Iowa.
If there was a medical emergency requiring transportation to Holy Family Hospital 60 years ago, the only choices were:
n Be driven by a family member or neighbor.
n Be transported in the back of a hearse by staff of any of the local funeral homes.
It was an occasion to remember when the Fuhrman Funeral Home of Graettinger and Estherville purchased a new Cadillac combination ambulance-hearse in September 1966. The vehicle was fully equipped with modern facilities for all types of emergencies.
By 1967, it was obvious that the role funeral directors assumed in handling ambulance duties at almost no cost at all to the public was pretty much over.
The only sensible solution was that the community provide this service or at least pay for it.
And that is how it was until 1971 when the announcement was made by Frank Fuhrman that the new Community Ambulance Service, Inc. included three ambulances and an additional standby unit for the newly organized company. At that time, Fuhrman recruited a staff of six ambulance drivers.
The organization of the new ambulance service was more or less prompted by the decision made by the Reese-Henry Funeral Home staff to discontinue its ambulance service. Many hours of negotiations, studies and discussion were devoted to how an ambulance service could be provided under conditions of rising costs so the operational costs could be shared by the Fuhrman business, Holy Family Hospital and Emmet County. All billing and accounting was handled by Holy Family Hospital at no cost to the new ambulance firm or to the county, while Emmet County reimbursed the service for accounts that were not collected within 45 days.
Of interest is that the ambulance charges effective July 1, 1971 were a minimum of $25 per call plus 50 cents per mile (one way). An additional $5 was charged for emergency calls and $5 additional for calls after 6 p.m. or on Sundays.
By the early 1970s, billing procedures were complicated by Medicare rules, insurance plans and other regulations in place. Problem accounts were turned over within 45 days to the Emmet County Auditor's office for reimbursement of the community Ambulance Service.
News accounts of the day noted Fuhrman organized a large group of individuals to make ambulance trips. Steps were taken to train the personnel in first-aid procedures through the hospital, nursing staff and Iowa Lakes Community College.
Current Estherville Ambulance Administrative Director Gene Haukoos said in 2013, the Emergency Medic Tech course is 140 hours and participants are required to pass state and national testing. This hopefully leads to a 2-year certification. There is an additional 24 hours of continuing education required very two years. The cost for the EMT class is over $1,250 per student.
The possibility of receiving assistance through grant dollars was thoroughly researched for purposes for an additional vehicle.
The county's board of supervisors had considered a plan to subsidize both the Reese-Henry and Fuhrman Funeral Homes but the failure of the Iowa Legislature to pass an expected ambulance enabling act erased the idea. Under the law at the time, counties had to receive monies owed for service if they were permitted to assist in funding ambulance services. The two firms had asked for $6,000 per year each, in addition to fees collected.
When it became clear that bill 328 would fail, the Reese-Henry firm chose to withdraw from service totally, and further discussion and study led to a plan finally agreed upon of sharing the burden by Fuhrman, the hospital and the county.
In 1977, the ambulance service acquired the "Porto-Power" unit that was designed to pry doors off of badly damaged vehicles, push a collapsed roof off a trapped driver, or perform any number of rescue functions. This equipment was only part of the full complement of first-aid and rescue equipment carried by a new ambulance that Fuhrman acquired at a cost of $23,500. Other modern features included an intercom system for the first-aid providers and the driver, electrical outlets for baby incubators, flood lights, a full array of splints, oxygen gear and an entire complement of miscellaneous first-aid supplies.
"At present, the cost of an ambulance is $150,000 and this price does not include equipment," Haukoos said.
But 36 years ago, there were three rescue units in the fleet for the Estherville area and a fourth one serving residents in Graettinger.
At that time, Fuhrman stated that there wasn't any other Iowa county that had an ambulance service operating any cheaper to the county. The basic charge in 1977 was $30 per trip and 75 cents per mile.
Fuhrman's ambulance service also offered an air ambulance. Owned by Fuhrman, the plane was available 95 percent of the time for transporting patients and was the only one of its kind in Northwest Iowa.
The major change in the past 60 years is the charges the patient is responsible for care and transportation.
"Prior to 1971, there was little to no cost to the patients," Haukoos said. "The 1971 base fee was $25 per call and 50 cents per mile one way. By 1977, the base fee was $30 a call and 75 cents a mile one way. In 2013, the base fee is $676 and $15.75 one way."
The director is proud of the fact that team work still rules as it did 60 years ago with Emmet County, City of Estherville, Avera Hospital and the ambulance service still working together," Haukoos said. "We still have a great group of volunteers staffing the ambulance service with three ambulances. In 1999 we were awarded the Iowa Volunteer Service of the Year Award."
Haukoos commented how the training aspect has intensified over the years.
"Our training has gone from a few hours of first aid training to a minimum requirement of 140 hours to be an EMTl," said Haukoos. "You must be certified in the State of Iowa and you must attend 24 hours of con-ed every two years to maintain the certification."
Another change is how emergency calls were received. Back in the day the call came in on the telephone which meant someone had to staff the phone live 24-7.
"Someone on the ambulance staff would have to stay home near the phone at all times," said Haukoos. "Then there were handheld radios. The call would come in and the duty crew would be summoned to respond. Technology's next answer was the pager. This gave the duty crew freedom to move around town yet be contacted in case of an emergency."
He added, "As ambulance systems moved toward where we are today, our community ambulance service was proactive and ahead of the rest of the state. Today we are still setting trends. In the early 90s, Emmet County set up a countywide EMS system with a medical director and the first of protocols to provide a standard of care countywide. Put into place was an Emergency Responders Association that includes the Hospital, all Emmet County Fire, Ambulance, Law Enforcement, Emergency Management, Public Health and Iowa Lakes Community College.
Since Sept. 9, 2001 through 2010, the ambulance service has received nearly $200,000 in grant money for equipment and education.
"Since 2010 grant funding has dried up. But we still receive a training grant of $3,000 annually," Haukoos said, noting, "This will not cover the cost of annual training requirements."
Another aspect that has changed over the years is the patient payment method.
"From the beginning, receiving payment for services has been a major issue," he said. "The county and the City of Estherville have assisted the service with money to ease the debt."
Haukoos added, "With the changes in healthcare payments, the number of uninsured or underinsured has risen. Medicare and Medicaid pay less now than they did last year. This means our cost is going up and our reimbursements are less!"
As for flying ambulances, both helicopters and fixed wing aircraft are at the disposal of emergency staff.
An interesting note is that in Iowa there is no requirement for any city or county to provide ambulance service.
"The Iowa Legislature failed to pass a law to this effect in 1971," Haukoos said. "There was a similar bill introduced this year dealing with the standards of care and requiring the counties to ensure there be an ambulance service available in all 99 counties. But the fact that there is no money to help the counties with the cost of service, the measure failed to pass."
The director concluded by saying, "Without our volunteers and the support that we receive from our patients, the county, city, hospital and others, there would not be an ambulance service!"