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Amid Rural EMS Struggles, North Dakota Lawmakers Weigh Solutions

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Amid Rural EMS Struggles, North Dakota Lawmakers Weigh Solutions


North Dakota lawmakers are exploring using telemedicine technology to ease staffing strains on rural emergency medical services, a potential solution to a growing shortage of paramedics and volunteer responders across the state.

Though some solutions were floated and passed during the 2025 legislative session, lawmakers are working to understand the scope of the problem before proposing additional legislative changes in 2027.

The state has been facing a societal decline in volunteerism, which strains traditional volunteer firefighter and emergency medical services that support rural communities, said Sen. Josh Boschee, D- Fargo. Adding to pressure, when a rural ambulance service shuts down, the responsibility falls to neighboring ambulance services to answer calls in the defunct ambulance service’s coverage area.

How could telemedicine ease strains on rural EMS staffing?

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One idea presented to the Emergency Response Services Committee on Wednesday to potentially alleviate some of the stress on rural ambulances is expanding access to technology in the field for emergency medical personnel.

Emergency medicine technology company Avel eCare presented to the committee its system, which allows ambulance personnel to be connected by video with emergency medicine physicians, experienced medics or emergency nurses in the field wherever there is cell reception. The company already operates its mobile service in South Dakota, Minnesota, Nebraska and Kansas, according to the company’s presentation.

Avel eCare said this allows medics and paramedics to have any questions they have answered and provides a second person to help document actions taken when there is only one person in the back of an ambulance with a patient, which they say is increasingly common in rural areas. This allows one medic or paramedic to put more focus on the patient.

The company said it is innovating the ability to also bring medical personnel into the call from whatever care center the ambulance is heading to, allowing the care center to better prepare for the ambulance’s arrival.

Lawmakers said they were interested in the system and could see how it would provide a benefit to thinly stretched EMS personnel.

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Boschee said the state should consider funding the system, citing its potential to support local EMS providers and help retain volunteers.

Avel eCare did not provide a cost estimate for North Dakota, but offered South Dakota as an example. That state used general fund dollars to provide the Avel eCare service free of charge to agencies. The state paid $1.7 million in up-front costs for equipment — enough to outfit 120 ambulances — and an annual subscription cost of $937,000 to provide their services to 109 ambulances serving 105 communities in the state.

“I think specifically … how affordable that type of solution is for us to not only support our local EMS providers, but also to keep volunteers longer,” he said. “Folks know that they have that support network when they’re in the back of the rig taking care of a patient. That helps add to people’s willingness to serve longer. And so I think that’s a great, affordable option we have to look at, especially as we start going in the next couple months and continue to talk about rural health care transformation.”

Rural EMS shortages go beyond pay, state officials say

There are 28 open paramedic positions in the state, according to Workforce Services Director Phil Davis’ presentation. The difficulty in filling these positions is not just about money, though that certainly plays a factor in recruiting people, his report said.

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“I’ll just speak from my experience with my own agency,” Davis said. “After 18 years, it’s very hard for us to even recruit individuals into Job Service North Dakota because of the lower wages.”

Davis showed that 2024 salaries for emergency medical technicians were fairly even across the eight regions Workforce Services breaks the state into, with a roughly $6,500 gap between the highest and lowest averages. Law enforcement officer pay varied by about $8,320, while firefighter salaries were the biggest outlier, with a $20,000 difference between regions. While state wages may lag nationally, other factors are making rural recruiting particularly difficult.

Davis said it was largely a lifestyle change; people are not seeking to live rurally as often.

“We’re starting to see the smaller communities, for the most part — not all — starting to lose that population. And it is tougher to get individuals to move there or to be employed there,” Davis said.

Job Service North Dakota is holding job fairs to try to recruit more emergency services personnel, with some success, he said, and has nine workforce centers across the state working directly with small communities to help with their staffing shortages.

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Davis advocated for more education in schools about career paths in emergency services and the openings that are available in the state.

© 2025 The Bismarck Tribune (Bismarck, N.D.). Visit www.bismarcktribune.com. Distributed by Tribune Content Agency, LLC.

 



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ND Supreme Court Justice Daniel Crothers retiring, stepping onto new path

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ND Supreme Court Justice Daniel Crothers retiring, stepping onto new path


BISMARCK, N.D. (KFYR) – The North Dakota Court System threw a reception for a retiring member of the state Supreme Court.

Justice Daniel Cothers is leaving after serving for more than 20 years.

He plans to step down on Feb. 28.

Before Crothers became a judge, he served as a lawyer and as president of the State Bar Association of North Dakota.

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Mark Friese is set to replace Crothers starting March 9.

“He knows what is important and what to keep focused on. Justice Friese will be an exceptional replacement to me on the bench,” said Crothers.

Crothers plans to keep up on teaching gigs and spend time at his family’s farm as he steps into retirement.



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North Dakota ambulance providers losing money on every run, according to survey

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North Dakota ambulance providers losing money on every run, according to survey


By: Michael Achterling

FARGO (North Dakota Monitor) – North Dakota ambulance service providers lost nearly $500 on average for every patient transported to a medical facility last year, according to a survey.

The recent survey of three dozen providers in the state, conducted by PWW Advisory Group, was the result of a study created by House Bill 1322 passed during the 2025 legislative session.  The group presented the results to the Legislature’s interim Emergency Response Services Committee on Wednesday.

The average revenue generated from an ambulance transport was about $1,100 during 2025, but the expenses were nearly $1,600, said Matt Zavadsky, an EMS and mobile health care consultant with PWW, based in Pennsylvania.

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“They are losing money every time they respond to a call,” Zavadsky said during the meeting. “That financial loss has to be made up, typically, by local tax subsidies, fundraisers, bake sales, or all too often, service reductions to try and match expenses with the revenue they can generate.” 

He said the problem cannot be fixed by billing reform alone because the revenue generated isn’t enough to fund the cost of readiness, such as personnel, equipment and supplies, among other items.

The survey highlighted 74% of ambulance provider expenses went to personnel costs, but equipment costs have also increased in recent years.

Zavadsky said survey respondents plan to invest about $12.9 million into vehicle and equipment purchases over the next five years, averaging to about $358,000 per provider. However, the cost of a new ambulance has risen to between $275,000 to $480,000 per vehicle. Prior to the COVID-19 pandemic, a new ambulance could cost up to $250,000, he said.

There are more than 100 ambulance service providers in North Dakota. The 36 survey respondents represented a diverse group of providers from city and county services to district-owned, hospital-based and private providers, he said. The average patient transport distance is 34 miles, according to the survey.

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Zavadsky said the survey respondents reported 53% of their total revenue was generated from fees for service with the remaining 47% coming from local tax subsidies, state grants and other fundraising.

“What you guys are experiencing in North Dakota and what is happening in the local communities … is not the fault of the local communities, not the fault of the state, this is just our new normal,” Zavadsky said.

Rep. Todd Porter, R-Mandan, owner of Metro-Area Ambulance Service which serves Morton and Burleigh counties, said Medicare patients reimburse ambulance providers at a much lower rate than private insurance and Medicaid patients. He added Medicare patients make up about 60% of the call volume in the Bismarck-Mandan area.

“If we’re being underpaid for 60% of our call volume, then we have to make it up some place,” Porter said.

He said some providers can make up that difference in reimbursement with tax dollars, but not all providers have that option.

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“We do other contracted work for nursing homes, hospitals, funeral homes in order to make up that difference,” Porter said. “This is a federal government problem. This is a CMS (Centers for Medicare and Medicaid Services) problem that we’ve known about for years.”

Porter also said ambulance services are not reimbursed for responding to a call with a Medicare patient that doesn’t require a transport to a hospital. According to the survey, about 17% of all ambulance calls don’t require transport to a medical facility.

The survey also showed about 2,300 of the nearly 33,600 patient transports billed last year ended up in collections after being more than 90 days delinquent, totalling $2.7 million, Zavadsky said. The average total of a claim sent to collections was about $1,100.

Zavadsky estimated the total of unpaid claims for more than 100 providers across North Dakota was about $5.8 million in 2025. Some providers don’t have procedures to pursue delinquent billing in collections, he said.

Rep. Jim Grueneich, R-Ellendale, chair of the committee, said the committee will take a deeper look at the data presented on Wednesday and may have recommendations, and possible draft legislation, to address the issue in the 2027 legislative session.

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Judge orders Greenpeace to pay $345m over Dakota Access pipeline protest

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Judge orders Greenpeace to pay 5m over Dakota Access pipeline protest


A North Dakota judge has said he will order Greenpeace to pay damages expected to total $345m in connection with protests against the Dakota Access oil pipeline from nearly a decade ago, a figure the environmental group contends it cannot pay.

In court papers filed Tuesday, Judge James Gion said he would sign an order requiring several Greenpeace entities to pay the judgment to pipeline company Energy Transfer. He set that amount at $345m last year in a decision that reduced a jury’s damages by about half, but his latest filing did not specify a final amount.

The long-awaited order is expected to launch an appeal process in the North Dakota supreme court from both sides.

Last year, a nine-person jury found Netherlands-based Greenpeace International, Greenpeace USA and funding arm Greenpeace Fund Inc liable for defamation and other claims brought by Dallas-based Energy Transfer and subsidiary Dakota Access.

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The jury found Greenpeace USA liable on all counts, including conspiracy, trespass, nuisance and tortious interference. The other two entities were found liable for some of the claims.

The lawsuit stems from the pipeline protests in 2016 and 2017, when thousands of people demonstrated and camped near the project’s Missouri River crossing upstream of the Standing Rock Sioux Tribe’s reservation. The tribe has long opposed the pipeline as a threat to its water supply.

Damages totaled $666.9m, divided in different amounts among the three Greenpeace organizations before the judge reduced the judgment. Greenpeace USA’s share of that judgment was $404m.

Energy Transfer previously said it intends to appeal the reduced damages, calling the original jury findings and damages “lawful and just”. The Associated Press contacted the company for comment on the judge’s Tuesday action.

In a financial filing made late last year, Greenpeace USA said it does not have the money to pay the $404m ordered by the jury “or to continue normal operations if the judgment is enforced”. The group said it had cash and cash equivalents of $1.4m and total assets of $23m as of 31 December 2024.

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Greenpeace declined to comment on the judge’s filing, but Greenpeace USA interim general counsel Marco Simons reiterated that the organization could not afford the judgment.

“As mid-sized nonprofits, it has always been clear that we would not have the ability to pay hundreds of millions of dollars in damages,” Simons said Wednesday.

Simons added that the case is far from over and expressed optimism about the group’s planned appeal.

“These claims never should have reached a jury, and there are many possible legal grounds for appeal – including a lack of evidence to support key findings and valid concerns about the possibility of ensuring fairness,” Simons said.

Greenpeace has said the lawsuit is meant to use the courts to silence activists and critics and chill first amendment rights. The pipeline company has said the lawsuit is about Greenpeace not following the law, not free speech.

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At trial, an attorney for Energy Transfer said Greenpeace orchestrated plans to stop the pipeline’s construction, including organizing protesters, sending blockade supplies and making untrue statements about the project.

Attorneys for the Greenpeace entities said there was no evidence for the oil company’s claims, and that Greenpeace employees had little or no involvement in the protests and the organizations had nothing to do with Energy Transfer’s delays in construction or refinancing.



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