There is no dedicated ambulance service for the community of Walton. First response to medical calls and traffic accidents comes from the volunteer fire department — which has no plans to start an ambulance service anytime soon.

There are two real reasons there is no dedicated ambulance for Walton — one is the "excellent service and coverage" fire chief Merlyn Johnson says the town gets from nearby Newton and Hesston — both paid departments. The other is staffing for what would be a service relying on volunteers.

"You have to staff an ambulance before you can get a state license; you have to staff an ambulance 24 hours a day, seven days a week, 365 days a year. That is not easy, especially when you are talking volunteer," Johnson said.

His fire department, which contains trained EMTs for first responder services, has 16 people. There is a need for more — Johnson said he'd like to have 20. Recruitment of volunteers is a constant effort for his department.

"If we can add two or three a year for the next several years, we will be OK," Johnson said. "We need good people who are willing to give of their time and that is hard to find anymore."

The challenge of staffing volunteer departments is not a new challenge or one that is unknown. In 2015 the Journal of Emergency Services wrote, "In recent years, many studies across the county have attempted to figure out a solution to our staffing problem. Specifically, a study performed by the North Carolina Rural Health Research & Policy Analysis Center in 2008 brought to light many of the issues faced in North Carolina that could easily be expanded to encompass the entire nation. According to this research, only 50 percent of EMS services in 2008 were fully staffed, of which, more than 63 percent had a volunteer component as part of their staffing level."

According to the journal, these issues have arisen as training, certification and continuing education requirements have increased. When asked about difficulties retaining personnel, more than 65 percent of volunteers reported that time and scheduling conflicts contributed to retention problems.

"It takes a lot of time," Johnson said. "It is a big commitment we ask for."

At Hutchinson Community College, which offers two different training programs for prospective EMS workers, graduates of training programs can not be produced fast enough.

The college trains EMTs and paramedics at several different locations — including classes in Newton.

Cliff Moore, director of the EMT programs at the college, told The Kansan the class about to graduate has 11 students. Seven of those already have full-time, paid positions waiting for them when they graduate. That does not bode well for volunteer departments looking for help.

"I am taking calls from different services ... They are coming in and recruiting our students because they need paramedics," Moore said. "... We can not turn them out fast enough. We can not."

Moore said the biggest challenge is with those who work other jobs full time — often too far away from home to respond within a five-minute window that is required for EMS.

With the volunteer fire department offering first response, and the proximity to Newton and Hesston, Walton has been able to prevent some of the problems that come with not having enough EMTs or an ambulance service: a taxed response system, increased response times and patients without adequate levels of care.

"This is happening all over the state of Kansas," Moore said. "It is working its way up to paramedics, too. Especially for the littlest services. The littlest services are always sending students to us to fill the needs they have. ... The demand of being on call 24/7 takes a toll. We are producing one year at a time, and if we can get them out there and they stay a year or two, they are doing good."

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Walton is not the only town in Harvey County that does not have a dedicated ambulance service within the city limits.

In Sedgwick, numbers on the volunteer EMS staff dwindled to the point where the department had to reach an agreement with the Halstead and Newton departments to help covering calls in 2016 before the former fully relinquished its license in early 2017 (and came to an agreement with Halstead to provide its current services).

Former Sedgwick Fire and EMS Director Tom Richardson saw the writing on the wall when he took over the position in 2015. While there were about 15 volunteer EMS staff on the roster, he immediately noticed that the majority of calls were being handled by about four or five of the volunteers.

"You can't do that and cover 24 hours a day, seven days a week," Richardson said.

When Richardson started as a volunteer with the department in 1987, he noted there were no issues finding volunteers — with the department even having to turn away potential members in certain cases. Richardson went on to a full-time position with the Sedgwick County Fire Department before returning to Sedgwick after he retired, which he noted gave him some perspective in seeing the latter was not alone in its struggle to find the necessary volunteers.

Low volunteer numbers is not an isolated issue — as Richardson said departments both statewide and nationwide are having similar struggles. The biggest factor, he said, may be the general hang up regarding volunteerism itself.

"It's tough. You have to spend four to five months going to school to get your state EMS certification, and then you're gonna go on call, which means you can't go anywhere, you can't go out to eat, you can't leave town," Richardson said, "you're stuck, you're waiting on that call, and then you get $10 or $15 to go on that call and you're gone for three hours."

Unwillingness to commit to that on a volunteer basis has created some issues, certainly, but Richardson also said the increasing requirements for state certification may have deterred potential volunteers as well — a concern, as he said that 85 percent of a volunteer department's calls are related to medical issues.

Richardson noted that when he started 30 years ago, only one certified EMT was required to go out on a call — while a volunteer firefighter could help drive the ambulance. Now, that is no longer the case with new state regulations requiring two certified EMTs on all calls.

Additionally, Richardson noted it has never been much of an issue to recruit volunteer firefighters because of minimal certification requirements, but EMTs are a different story as the state continues to strive for a quality of care that calls for more training — from an initial six weeks to nearly six months now — and continued education.

"On the EMS side of things, there's constant, continuous education that has to be done, which means you're not only on the clock as a volunteer EMT, you also have to take your spare time and go to classes to continue your education," Richardson said. "That, coupled with the class and the time; people don't want to do it anymore."

Some communities — like Burrton and Moundridge — have bucked the trends and been able to keep their departments staffed with volunteers.

Burrton has not seen any drastic changes across its volunteer department in recent years, as Fire Chief Jon Roberts noted staff numbers have remained fairly steady over the last five years — with 18 certified EMTs and EMRs currently on the roster.

A couple of those members just completed certification through Hutchinson Community College, thanks in part to a course now offered on Saturdays, but Roberts admitted he, too, has seen the challenge departments face with the increasing hours required for the training and continuing education.

"That's one of the biggest hurdles because people just don't have that time to go do that anymore in the evenings; they've got so many other things going on now," Roberts said.

One advantage the department has built in, according to Deputy Chief Sherry King, is that two hours of training are offered at the regularly monthly meetings — which counts towards the 28 hours of continuing education required every two years.

The Moundridge Emergency Medical Services department is responsible for people scattered over 165 square miles — and providing mutual aid for neighboring departments in McPherson, Hesston, Inman — with just two ambulances and 20 volunteers.

"We kind of have a big area, but my goal is to provide the same care here that you would get anywhere else," said Moundridge EMS Director Brian Falco.

Falco made some changes to the department since starting in the position of director in Oct. 2017 — most notably changing the pay rate for volunteers.

"We're paying an hourly wage now, which has kind of attracted some more people," Falco said.

Depending on their certification level, Moundridge EMS volunteers earn at least $7.25 per hour while on duty.

"I have limited resources. I do well to staff one truck," Falco said.

Falco is the only full-time employee and teaches as many classes at the station as he can, bringing in other instructors there as well to make sure everyone is on the same page.

"Bringing the education to the people instead of sending people to the education is more efficient," Falco said. "I've brought the education here so we're not spending that money on education, I'm supplying it."

Keeping the station staffed 24/7 and trying not to rely on outside assists is a priority for Falco.

"It's not fair to have somebody wait while we get an ambulance from McPherson or Hesston or something like that," Falco said. "They deserve the same care as everybody else, and that really is my drive. Just because we're in small-town America doesn't mean your heart attack is any less significant."

Making sure the ambulances are outfitted with updated equipment is another goal for the department. Having gear similar to what is found in larger cities makes it easier for volunteers transfer in and out as needed — and provides better resources for the patients Moundridge EMS serves.

"We need to provide the good stuff, be we've got to figure out the funding to do that," Falco said. "It's always a challenge."

The Moundridge City Council recently approved $67,000 for new monitors to replace aging equipment, Falco noted.

"The council has been extremely kind to my requests," Falco said. "I've had nothing but support in this city to get things kind of progressing."

Falco said he would like to add people to the EMS department — providing they are willing to work to contribute to the community.

"Here's the double-edged sword to this — I don't just need people, I need good people. I need people who will be compassionate, have a little bit of education and are willing to learn," Falco said.