Home Care In Olin, IA

In some parts of Iowa, 911 callers can’t be assured an ambulance will arrive

Radu Denghel always had been interested in medicine, but when it came time to decide what to study in college, he picked engineering — which also interested him but would require less time in school.

While going to engineering school in Romania, where he is from, Denghel also attended some classes at the local medical school and volunteered at the local emergency room.

Now, more than 20 years later, Denghel is in Iowa and still working in both fields — computer engineering in a full-time job with Collins Aerospace in Cedar Rapids, and medicine as a volunteer emergency medical technician for the Olin Ambulance service.

“I got to a point where my work pays my bills, so I don’t have to look for additional income and spend my time that way. And I really do believe that time is much better spent serving the community instead of just watching TV or whatever,” Denghel said.

But volunteer EMTs like Denghel are dwindling across the state, where emergency medical services are not considered an essential service statewide, meaning the Iowa Legislature does not regulate the service or provide funding for it. Two years ago, lawmakers passed a bill, Senate File 615, allowing voters in counties to declare EMS an essential service within their county and agree to pay taxes to support it.

But the availability of ambulances still is inconsistent across the state — especially in rural areas — and providers say more needs to be done to support a waning EMS force.

Even when EMS workers are paid and not serving as volunteers, ambulance providers struggle to maintain services due to high turnover, likely a result of low wages and increasing burnout. Pay for paramedics and EMTs in Iowa falls short of the state’s average wage of $25.73, with their mean wages falling at $23.31 and $17.74 respectively, according to the U.S. Department of Labor.

Low wages, combined with an average cost of more than $12,000 to obtain a paramedic’s license, mean filling the physically demanding job is increasingly difficult despite a growing need. A 2022 survey by the American Ambulance Association found that, nationwide, paramedic and emergency medical technician turnover can range from 25 to 45 percent annually — resulting in 100 percent turnover every four years or less.

Stresses on EMS providers

Emergency medicine can be physically taxing — carrying injured patients down tight stairways or out of the woods, for example EMS providers face some of the highest rates of on-the-job injuries. In 2020, almost 17,000 EMS providers in the United States were treated in the emergency room for injuries sustained on the job, according to the national Centers for Disease Control and Prevention. Many of the sprains and strains seen in the emergency department — 56 percent — were from overexertion, typically from carrying patients much larger than the provider.

Mark McCullough, legislative chair for the Iowa EMS Association, said technologies like stair-chairs and automatic gurneys help reduce injuries, but the equipment is expensive and some services — especially those relying on volunteers — don’t have them.

He also pointed to the high rates of burnout and suicide in health care workers as reasons many providers are leaving the field or moving to urban services that pay more.

Volunteer services struggle more than paid services to keep and retain providers, McCullough said. This is due to the massive time and financial commitment volunteer services require.

While Denghel was studying to get his EMT certification earlier this year, for example, he said he was working about 60 hours per week at his job and attending about eight hours per week of EMT training. Now he often has to plan his schedule around the availability of the other volunteers, so someone is always reachable in an emergency.

Kevin Stoolman, fire chief of Eastern Iowa’s West Branch, said rising costs leave many volunteer services like West Branch Fire stretched thin. The department provides fire and emergency medical services the town of 2,500, providing lifesaving care until a transport team from Tipton, West Liberty or sometimes Davenport arrives to take the patient to a hospital.

“Our goal is to have them packaged up and ready to go by the time the ambulance gets there,” Stoolman said.

But Stoolman said a rise in the number of calls the department has to answer is stressing the team and diverting money traditionally budgeted for fire protection and fire fighting to emergency medical services instead.

Minutes can matter

According to data from the Iowa Department of Health and Human Services, 75 percent of Iowa’s EMS services are entirely volunteer, though those volunteers respond to only about 10 percent of EMS calls in the state.

Paid EMS services handle most calls in Iowa, but not all areas have enough paid emergency transport staff to cover the need, causing them to rely on other ambulance services to help pick up the slack. This can lead to longer wait times for care.

Katrina Altenhofen, the interim director of the Washington County Ambulance Service, said Iowa lacks a standard of operation for ambulance services and the ongoing workforce shortage strains an already stressed EMS network.

When a lack of staff causes a service to decrease the number of ambulances it runs, other nearby services may be required to pick up calls outside their normal coverage area — resulting in longer response times in both areas, Altenhofen said.

“You have communities within the state of Iowa right now that don't even have ambulance services and don't have a hospital,” Altenhofen said. “So they are at the mercy of whoever is that next closest entity to be able to come down and help.”

Cedar County Sheriff Warren Wethington said ambulances in Cedar County can take between 15 and 45 minutes to respond to an emergency call, depending on what else is going on and where in the county the call comes from.

“Just last week, we had the Clarence ambulance out of service. Tipton has two ambulances and they went to take somebody to Iowa City and somebody to Cedar Rapids, and there was another call … and there wasn’t anybody to cover it. We had to wait until the crew came back from Cedar Rapids,” Wethington said.

All the ambulance services in Cedar County currently are volunteer, but Wethington has been working with other county officials to create an EMS referendum that will be on the ballot Tuesday. If passed, the referendum would allow the county to implement an additional property tax of 75 cents per $1,000 of taxable value. The tax would be used to create two paid ambulance services and possibly an additional volunteer service.

Wethington said some people have expressed concerns about the already existing ambulance services losing out on revenue they use for upkeep of equipment and other necessary expenses. But he stressed the new ambulances would not be meant to replace the volunteer services, but provide backup.

“I want to make it very clear that we want a partnership. We don’t want to take anything away from anybody. This is purely a backup for when they’re out of service, don’t have a crew, or are out on another call,” he said.

If the referendum is approved, Wethington said it could take up to two years before the new ambulances are fully operational.

Few counties have adopted EMS tax

Only a handful of Iowa counties have voted to make EMS an essential service and levied taxes to support it — leaving much of the state hanging in the balance.

Jones County is one of the five counties where voters approved a levy in November 2022. Brenda Leonard, the Jones County emergency management coordinator, said the county’s two full-time ambulances and multiple volunteer ambulances all have been understaffed and overly busy recently. She said many of the volunteers hold fundraisers to pay for equipment and training, and she’s hoping the new levy will mean paramedics no longer have to spend as much of their time fundraising.

“I think it has brought to light in our county that it was not an essential service. When you called 911, you were not necessarily going to get an ambulance,” Leonard said.

Sheila Frink, services director of the Anamosa Area Ambulance Service — the largest service in Jones County — said that Anamosa’s service is planning to use the money they will receive from a levy approved there to buy a new ambulance.

Anamosa’s ambulance staff are not volunteer, but the tax levy cannot be used for salaries. It can go only toward training, equipment and other expenses.

Washington County has not passed a tax levy for ambulance services, but the county has been fully funding emergency medical services since 2020 when supervisors used general county funds to purchase several ambulances and the building they were kept in from a private owner, according to interim director Altenhofen.

The county previously had subsidized the ambulance service in varying amounts each year, but took over completely when a contract with the private ambulance service ended. Since buying the ambulances, the funding has come from the county general fund and also the revenue brought in from the ambulance service, Altenhofen said.

The county also developed a Washington County EMS Council in 2020 that is working to put a tax levy for the ambulance service on the ballot in coming years.

“The Board of Supervisors recognized the need to be able to offer the citizens of the county emergency care. Waiting on an ambulance to come from Iowa City, Mount Pleasant, Marengo or Fairfield just was not a viable option,” Altenhofen said.

Since EMS still is not considered an essential service statewide, there is no obligation for ambulance services to take calls from other areas. In areas where EMS is not declared an essential service, there is no guarantee an ambulance will come at all when a patient calls 911. Many counties that rely on volunteer services don’t have a hospital, and many don’t have the tax base to help support the service, Frink said.

“It's a broken system,” Frink said.

Liam Halawith, a University of Iowa student who is senior politics and news editor for The Daily Iowan, served earlier this year as an intern reporter for The Gazette.

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Four Iowa Lakes students were selected to attend the exclusive Okoboji Entrepreneurial Institute (OEI).

Every August, OEI brings 32 students from Buena Vista University, Iowa Lakes Community College, Iowa State University, University of Iowa, and the University of Northern Iowa to participate in a week-long college credit course focused on entrepreneurship and teamwork. This year Iowa Lakes students Zoey Zeller of Ottosen, Dawson Hatch of Greenville, Ethan Marth and Olin Myhre of Estherville were selected for participation.

“The Okoboji Entrepreneurial Institute sounded like an excellent opportunity to expand my learning and do it in a non-traditional way. I am a massive believer in non-traditional, outside of the classroom learning, and to me, that’s exactly what OEI is. During my time here, I want to increase my knowledge and passion for sales and marketing. I also want to dig into the other factions and degrees that go into business and entrepreneurship,” said Myhre, a sophomore majoring in Sales and Marketing.

The course consists of educational seminars, entrepreneurial venture computer simulations, networking with area entrepreneurs, pitch competitions, and fun on Iowa’s Great Lakes beaches.

“I applied to go to OEI because it sounded like an amazing experience where I would make some great connections and learn how to further my business that I already have begun. I hope to learn some new skills about how to build my business, and I hope to make some long-time connections with people to who I can ask business questions too even after OEI is over,” explained Zeller.

Zeller, a sophomore pursuing a Sales and Marketing degree, has already started her first business called Rural Creations, which focuses on longarm quilting for custom orders and sells baby quilts and wood signs. Zeller will be attending the Algona craft fair this year in October with her quality handmade products.

Hatch, a Junior pursuing Business Economics, applied for OEI because his business teacher Lecia Berven, an Iowa Lakes Instructor who recently retired, recommended the program.

“It looks like an excellent opportunity to gain a lot of great information. One of my friends’ brothers went to OEI and had a great experience. I hope to learn more about business and what it took for the host families to be successful. I’m looking forward to meeting new people and creating contacts,” shared Hatch.

Marth, a recent Iowa Lakes graduate with an Associate of Arts, focused on taking courses geared towards music, business, and entrepreneurship while attending Iowa Lakes and plans to obtain a Bachelor’s degree in Digital Cinematography in the future.

Marth explained, “OEI came highly recommended by a couple of my professors at Iowa Lakes, and after looking into it and hearing nothing but good things about it both online and from past class members, I decided to apply. With the potential to learn quite a bit more in the business realm, it came as one of the best entrepreneurial opportunities in northwest Iowa. As a student interested in business and entrepreneurship – and especially in the small business and start-up arenas – I hope to gain as much insight and hands-on personal experience and skills through the simulation and lecture opportunities that OEI presents. I then hope to apply these skills to my future business ventures. I also hope to get to know some of the other entrepreneurs from around the area and hear their stories and firsthand knowledge gained through successes and failures.”

The Okoboji Entrepreneurial Institute is a cooperative effort of the State Board of Regents, the Iowa Department of Economic Development, the Pappajohn Entrepreneurial Centers at the University of Iowa, Iowa State University, and the University of Northern Iowa, as well as the Iowa Lakes Corridor Development Corporation.

The opioid epidemic has decimated many communities around the country. It has cost lives, harmed families, and upset the social fabric of a number of places. Around 69,700 people lost their lives in 2020 to opioid abuse in the United States.

To deal with this crisis, researchers at the Washington University Olin School of Business spent a year studying the issue and developing recommendations for mitigating the epidemic. Before an audience of policymakers, journalists, scientists, and healthcare professionals, these individuals and members of the Olin Brookings Commission outlined their solutions and recommendations to tackle troubling aspects of the opioid epidemic.

The six-member commission convened multiple times over the past 12 months and recently released a 53-page overview of the research process, policy recommendations and context—during an event at Brookings. The presentation outlined AI-driven tools to curb misdirection of opioid shipments and policy recommendations design to facilitate the use of these tools.

“As I listen to the presentation, I have this sick feeling in my stomach, thinking if we had these tools 10 years ago, how many lives could we have saved?” said Van Ingram, one of the members of the Olin Brookings Commission and executive director of the Kentucky Office of Drug Control.

The group was the first convened by WashU Olin as part of a partnership with Brookings underwritten by The Bellwether Foundation. The project was designed to explore quality of life issues in communities and recommend policy changes to address them.

Focus on diversion of prescription drugs

The report tackled the opioid epidemic and, more specifically, the illicit diversion of prescription opioids that exploited blind spots in the distribution supply chain, fueling decades of dependency and death. Once researchers had zeroed in on a data-driven answer to that problem, the six-member commission devised a series of policy recommendations to facilitate their use.

“The blind spots still exist,” said Anthony Sardella, the chair of the commission and a member of the research team. “Our goal: Can you use data science to remove these blind spots? With that focus our research was begun.” (See a full list of the 2021-22 Olin Brookings Commission members on the commission’s website.) According to some reports, more than 100 billion prescription hydrocodone and oxycodone pills were distributed in the United States between 2006 to 2014.

An AI-driven solution

Olin researchers from the school’s Center for Analytics and Business Insights focused on the patterns of diversion within the drug supply chain using advances in data collection, data mining, artificial intelligence, and machine learning. The solution: Olin researchers developed a suite of anomaly detection tools to identify diversion trends in data submitted to a database maintained by the US Drug Enforcement Administration.

Using historical data from the Automation of Reports and Consolidated Orders System (ARCOS) database from 2006 to 2012, including more than 400 million opioid transactions and 277,000 buyers, researchers developed a tool to flag and stop fraudulent opioid shipments before they are diverted. The team identified patterns among likely diverters and tested their findings against a known database of convicted buyers.

The tool is designed to flag future diverters with 100% precision accuracy (i.e., if the tool flags a buyer as a diverter, it is almost guaranteed that the prediction is correct). In other words, the tool will not produce false positives. The team achieved that level of precision accuracy because the tool “lives with” a moderate degree (51%) of recall accuracy (i.e., the tool catches about one-in-two diverters). In other words, the team was willing to live with a higher rate of false negatives to ensure 100% precision accuracy in flagging likely diverters.

Values-based, data-driven work

“This work is emblematic of what WashU Olin Business School represents,” said Mark P. Taylor, the Olin dean who initiated the work to gain the Bellwether grant. “We’re dedicated to applying the rigorous use of data and the careful consideration of our principles to go beyond the bottom line, to address and impact critical issues in society.”

Once the research team locked down its anomaly detection tool, the 2021–22 Olin Brookings Commission developed a series of policy recommendations that, in combination, can overcome existing policy obstacles to empower industry and government to work together and implement the team’s near real-time detection and alert system to thwart opioid diversion in the supply chain.

The 14 recommendations include establishing a daily or near real-time pilot for integration of the anomaly detection tool to test the operational methods and modernizing the ARCOS technology infrastructure to support daily or near real-time data entry by registrants. And the work is not done. The research team intends to further refine its model to potentially look for additional flags—and even techniques for flagging the movement of nonprescription opioids.

“We can determine whether a transaction is supposed to happen or not,” said Annie Shi, a member of the research team and a marketing PhD student at WashU. “For example, if DEA receives a new transaction request, then our model will be able to predict if that transaction is supposed to happen or not. If it is predicted to be suspicious, the DEA will be able to hold off that shipment until further actions are taken.”

I have to give credit where credit is due. I was swindled at a lemonade stand yesterday, which was hosted by a few kids. I'm guessing here but all three of them looked to be between the ages of 6-10 and they found the perfect customer to sell lemonade to...there's a sucker born every minute.

In 2021, there was a Tweet that went viral from a father whose daughter cashed in while hosting her own lemonade stand. What happened to me yesterday (July-6) reminded me an awful lot of this viral tweet.

According to Mirror, Eric Hulse Tweeted this back in July of 2021

My daughter made $110 on her lemonade stand today, in like an hour. Turned out people were handing her $5s and $10s and she was just assertively saying thank you for the tip, and not offering change.

Most of the internet found this pretty funny and thought it was a pretty cute story. Of course, you can't please everyone on the Internet. There were some individuals who thought this girl was stealing people's money and it wasn't okay.

I'm here to say, I was 100% okay helping out these young entrepreneurs and this is all in good fun.

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Yesterday, after going out to dinner, my fiance and I drove past these 3 kids selling lemonade. We both started joking about the lemonade stands we did when we were kids and we decided to turn around, pull over, and grab some lemonade. There was one problem, I only had my cards and a $10 bill on me. With technology these days, you just never know if the kids have a way for you to pay with a card. I thought, "Maybe they'll have something to swipe my card."

When I walked up to them I quickly realized this was a cash-only lemonade stand, so I asked them if they had any change. Sadly, they only had a $5 dollar bill and a $1 dollar bill in their "piggy bank." Each glass was $1, so what was the only choice to make? I gave them $10 for two glasses of pink lemonade and told them to just keep it. My kind heart be damned.

Was I swindled by these 3 young entrepreneurs? ABSOLUTELY! I was swindled by their adorableness and how excited they were to receive 10 bucks. I would've done anything for $10 when hosting a lemonade stand as a kid.

In the photo, you can see the lemonade did come with these great plastic red cups and straws, so I'd say the presentation of this item was pretty solid. That alone has to be worth a few bucks. They also had to make the lemonade and pour it into 2 cups, so that also has to be worth a few extra bucks on the tip. As I continue writing this, I'm starting to think I might've actually won in this transaction.

When I got into the car, I had to tell my fiance that I just spend $10 on two glasses of lemonade and she just laughed. She gave me a good reminder that "those kids need the $10 more than we do" and you know what, she was right.

I hope they don't spend it all in one place. I'm also not exactly sure how the 3 of them were going to split a $10 bill but I hope they at least shared.

Be careful the next time you go to a lemonade stand! You might be overwhelmed by the innocence of children and before you know it, you've left a 500% tip without even realizing what just happened.

Machines that learn are reshaping lives and livelihoods. Artificial intelligence (AI) is the most important change force in modern society, but it remains common for high school graduates to know nothing about how it works, the opportunities it creates and what we need guard against.

In May, the Association for the Advancement of Artificial Intelligence (AAAI) and the Computer Science Teachers Association (CSTA) launched the AI for K-12 Working Group (AI4K12) to define for artificial intelligence what students should know and be able to do. The AI4K12 steering committee includes David Touretzky, Carnegie Mellon; Christina Gardner-McCune, University of Florida; Fred Martin, University of Massachusetts; and Deborah Seehorn, CSTA Curriculum Committee.

With lots of input, the steering committee drafted five big ideas that every student should know. A summary of the report (available here) they will present at the AAAI conference in January follows.

Big Idea #1: Computers perceive the world using sensors. The ability of computers to “see” and “hear” well enough to be practically useful is one of the most significant achievements of AI. Students should understand that machine perception of spoken language or visual imagery requires extensive domain knowledge. Graduates should be able to identify and demonstrate the limitations of machine perception systems and use open machine learning tools to train perceptual classifiers.

Big Idea #2: Agents maintain models/representations of the world and use them for reasoning. Representation is one of the fundamental problems of intelligence, both natural and artificial. Students should understand the concept of a representation--the way a map represents a territory, or a diagram represents a board game. Students should further understand that computers construct representations using data, and these representations can be manipulated by applying reasoning algorithms that derive new information from what is already known. High school students should be able to make use of elementary data structures to program simple inference algorithms.

Big Idea #3: Computers can learn from data. Machine learning algorithms allow computers to create their own representations using training data that is either supplied by people or acquired by the machine itself. High school students should be able to train a network and code simple applications using open tools.

Big Idea #4: Making agents interact naturally with humans is a substantial challenge for AI developers. Understanding people is one of the hardest problems faced by intelligent agents. Inferring a person’s future intentions by observing their actions is challenging even for humans. Robots will need to acquire some of this skill if they are to be welcome in our lives. High school students should be able to construct context-free grammars to parse simple languages and use open tools to construct a chatbot. They should also be able to use sentiment analysis tools to extract emotional tone from text.

Big Idea #5: AI applications can impact society in both positive and negative ways. Students should be able to identify ways that AI is contributing to their lives. The societal impacts of AI involve two kinds of questions: what applications should AI be used for and what ethical criteria should AI systems be required to meet?

Students should understand that the ethical construction of AI systems that make decisions affecting people’s lives requires attention to the issues of transparency and fairness. High school students should be able to evaluate new AI technologies and describe the ethical or societal impact questions raised by them. AI4K12 will be developing guidelines but not curriculum. They plan to curate online resources for educators.