When you call 911 in these rural Southern towns,
you could have to wait hours for an ambulance to arrive.
I think we only have one.
So you waiting 30 minutes, in that 30 minutes, you’re gone.
Emergency medical services are nearing collapse in parts of rural America.
Rural hospitals are filing for bankruptcy
and shutting down.
And EMS workers are having to drive hours
to take patients to the nearest hospital.
We could potentially have to drive about two hours -
it’s going to take our unit out of service
three to five hours, depending on how far we have to travel.
Paramedics and EMTs are putting themselves on the line
to serve their communities.
From gunshots, from stabbings, from seizures, from heart attacks -
I can’t tell you how many times we’ve gone in on unsafe scenes
because patients are going to die if you don’t.
- This is a trauma tourniquet, in case, you know, we do get shot.
EMS is not considered an essential service in the vast majority of states.
And they are not guaranteed federal funding like fire and police departments are.
Many ambulance companies are privately owned,
and some resort to crowdfunding or bake sales to keep running.
I don’t think paramedics are valued at all.
Nobody really understands what we're doing
until they need a service that we provide.
So what happens to rural communities
when hospitals close
and there are no ambulances available?
We traveled to the Mississippi River Delta,
where EMS workers are grinding to keep ambulances running,
and where rural hospitals
are a distant memory.
I just want people to have a chance,
not trying to be God.
But, it’s like they’d rather for the Delta to die.
On July 5, 2021, Harmony Ball-Stribling
lay dying on the side of the road
outside Belzoni, Mississippi,
while waiting for an ambulance.
She was pregnant
and due to give birth to her daughter, Harper,
just five days later.
- Around here, everyone pretty much knows that
it takes the ambulance awhile
when you call.
So, get in your vehicle and drive,
is pretty much your best bet.
After Harmony began to have chest pains at home,
her husband, Byron Stribling,
started to drive her to the nearest hospital 30 minutes away.
The hospital in their hometown, Belzoni,
closed due to bankruptcy in 2013.
- I’m going about every bit of 1-, 105, right?
She was just kind of shaking, eyes rolled in the back of her head
and I'm driving.
And then she just stops all of a sudden.
I called the ambulance en route,
and she tells me to, you know, to pull over and start CPR.
I was literally about two minutes from the hospital.
By the time the ambulance got there, she was pretty much gone.
Since Harmony and Harper died,
Harmony’s mother, Shenelle,
has been questioning why they didn’t have access to health care.
Someone said, one nurse says,
“If she would've had oxygen on the baby could've lived.”
That stuck with me, even after, it just kept on - if, if, if,
and then I was like, “It shouldn't be no 'if.'”
Black, white, it don't matter what color you are or race or religion -
emergency care is for everybody.
Money for everything else.
But not this.
[Singing] He's got the whole world, in his hands, he's got the whole world...
As rural hospitals close,
ambulances are having to drive farther to transport their patients.
This is the case for EMS workers in Marianna, Arkansas,
a small town on the other side of the Mississippi River from Belzoni.
There is only one ambulance service for 620 square miles,
an area twice the size of New York City.
The closest hospital is in Helena, which is approximately 40 minutes away.
But that hospital doesn’t have an ICU
and recently closed the unit dedicated to childbirth.
Rural paramedics like Michael Tharp
are spending more time caring for patients in the back of the ambulance.
We work heart attacks, gunshots,
I've delivered babies in the back of this ambulance.
A lot of times if they call, their water's already broken
and they're already too far away from the hospital.
So in the process, I have delivered, or caught, between 20 and 30 babies.
We never know what we're gonna work on.
And we have to carry as much supplies as most of the hospitals do.
It has gotten worse for us because the hospitals are closing down.
- That's us. We're fixing to go.
When Michael and his crew go on an emergency call like this,
they often don’t know what they’re going to find.
In the most extreme cases, it could be a 12-hour round-trip ride
to transport the patient to the right facility.
On average, EMS workers make less than half the salary that nurses make.
And the turnover rate is between 20-30% of workers per year,
leaving ambulances scrambling for staff.
- Most every company I know is down paramedics.
The paramedics that you do have that are dedicated
are away from their families more and more.
But I'm getting calls all the time to work different places,
'cause they have no paramedics.
The next five years, things are gonna be critical because
the older folks like me that work all these extra days
are gonna be retiring.
There's nobody coming along to take our place.
So we are actually worried about the future for
our families, for communities.
- Show is on scene. 10.2. 10.2.
We did not follow Michael and his colleague, Lori, into the house
due to patient privacy laws.
- Now this is not an emergency, but God knows I’m glad to see you.
- Well, when they call us, we typically turn those lights on.
The patient refused to be transported to the hospital.
And this is not uncommon.
Rural ambulance services often get paid through reimbursements
from Medicare, Medicaid or private health insurance.
But they are usually only eligible for payment
if they actually transport the patient to the hospital.
- As far as the company goes, there’s no way for reimbursement.
When they call us, we don’t think about the money.
Our main interest is the person.
Jamie Pafford-Gresham is the owner of Pafford Medical Services,
which runs the ambulance in Marianna.
She says operations have become more difficult and expensive.
Since the beginning of 2020,
over 20 ambulance services in Arkansas have closed.
- You may actually respond to 10 things
during the day,
but you only transport three patients.
And at that moment in time,
that's all the provider has to go on,
is those three reimbursable calls.
Jamie’s family has been in the ambulance business for over 50 years.
She runs ambulance services across the South,
in Oklahoma, Louisiana, Mississippi and Arkansas.
You know, in the last two years, I continually get texts on my phone
of hospitals having to have closures
or their CT scan is broken and we can't
take patients there for specific reasons.
We have to figure out where we're gonna take the patient,
all while they're in the back of the 8-by-8 box
being taken care of by the medic.
It becomes my problem that I can't find a place for them to go
or that I'm having to travel extended distances.
Under federal health policy,
EMS is considered a transportation benefit.
It lands primarily under the U.S. Department of Transportation.
Only 11 states have legislation deeming it essential or required.
But even that doesn’t guarantee that they will be funded.
Most ambulance providers live from Medicare check to Medicare check
to ensure that they can make their payrolls and pay their bills.
I mean, you just saw a $250,000 rig go out the door.
Rural EMS is in a crisis.
If we don't pay attention to it, then we truly are gonna have a collapse of our system.
I feel like the ambulance provider has been pushed to the side
and told that they're not important and they're just an ambulance driver.
And my guys are so much more than that.
We are providing mobile health care in the communities in which we serve.
And sometimes unreimbursed health care.
Sometimes working in EMS can even be dangerous.
Ambulance crews are often the first on the scene in an emergency,
like after a drug overdose or a shooting.
Can you tell me what happened?
You had a lot to drink?
I’m going to get you some fluids, OK?
Just relax your arm for me.
The day before we arrived in Marianna, Arkansas,
Lori Richardson says she received death threats.
The last shift I worked, I actually ran a call for a cardiac arrest
and the patient's family was not happy with the way
that they assumed we were supposed to be doing our job.
And there was more than one death threat
put out for me and my partner at the time.
When people call 911, they're asking us into their life for their emergency.
It's really difficult to understand why they would, you know,
want to hurt us just for doing our job,
regardless of if they think that we've done it right or wrong.
You know, you've called us into this situation.
Lori’s crew will even wear bulletproof vests on the job.
The company provided them for the staff after previous assaults and death threats.
And Pafford purchased these for our crews in Phillips and Lee Counties.
This is a trauma tourniquet.
Most of us keep them in our vests
in case, you know, we do get shot.
I would rather have them than not, especially with the current situation.
In one nationwide survey, two-thirds of EMS workers
reported being physically assaulted on the job.
I’ve been assaulted several times.
I’ve had guns pulled on me in Helena.
Somebody came up to me with a baseball bat.
I’ve been slapped, cussed at, spit at.
Bland and his partner, a couple of years ago, almost got shot.
I don’t think people realize on a daily basis what we go through.
If you’re not paying attention, someone can easily
pull something out of their pocket and stab you.
And a vest only covers so much.
One hundred and thirty-eight rural hospitals have closed nationwide since 2010,
partly due to increased costs and low revenue.
But the vast majority of those hospitals are in Southern states
that refused Medicaid expansion.
Clarksdale, Mississippi, is just north of Belzoni.
It still has its own hospital, but it also takes
patients from nearby counties without hospitals.
The local ambulance crew says they’re often directed to other facilities.
The local hospital here has had to shut down
one of the floors, just due to staffing.
They've had to have nurses to come from other areas of the hospital to assist in the ER.
They don't have the capability.
Maybe they need a specialty doctor. Maybe they need a trauma center.
We don't get practitioners in that actually want to work in the area, because it's rural.
As an ambulance provider, we have to take those patients somewhere.
It could take anywhere from 45 minutes to an hour
to get to any major medical center from this general location.
We have the skill, knowledge, and procedures to potentially save a life
on each and every call.
And knowing that I did that is kind of what helps me sleep at night.
In Mississippi, nearly half of rural hospitals are at high financial risk.
And five of them have closed since 2010.
Shenelle still has a vivid memory
of the moment she learned that her daughter never made it to the hospital.
I got a call from Byron, and said she was unresponsive.
I wanted time to stand still, but it didn't.
And I knew Byron loved her and she loved him.
So what we have to think about being at the hospital,
getting the news of she been called, she passed.
He's there from putting her slippers or shoes on,
getting in the car, to being on side of a dirt road
in the morning by theyself.
We don't have that.
When there could have been a hospital 10 minutes up the road.
After Harmony died,
Shenelle and Byron began advocating
for a hospital by testifying in front of the local government.
- The ambulance was stationed here.
They was permanent here.
The triage unit.
Full-functioning hospital. It wasn’t small either.
And then, that was it. There was a closure.
Most of the time in rural communities,
we're used to going out of our way to get stuff.
But we didn't think we would have to travel to get emergency care.
Byron and Shenelle can’t be sure that a hospital or more ambulances
would have saved Harmony’s and Harper’s lives.
But they do know that rural towns like theirs deserve more.
I just want people to have a chance.
Not trying to be God.
But it's like they'd rather for the Delta to die.
But we on the bottom, you know, that's what they say.
But don't you know who on the bottom, holding everybody else up?
Our resources here — the cotton, the soybeans, the corn.
But we just a farming town. We just the South.
And that's how I feel they feel about us.
Byron inherited a funeral home from his grandfather
a few years before Harmony died.
He has been around death all of his life,
but nothing could have prepared him for this.
He hopes no one else will have to endure the pain
of their loved one’s untimely death, always wondering if it was preventable.
I understand that everyone is going to eventually leave here.
We just never know when,
we never know where, we never know how.
I just wouldn’t want people to experience a loved one leaving here
because of the lack of health care or health facilities, hospitals.
I wouldn't want anyone else to have to go through that.