INDIANAPOLIS (AP) — An increase in ambulance calls across Indiana and fewer emergency medical workers has officials raising concerns about longer response times and growing delays in moving seriously ill patients to larger hospitals.

The number of ambulance calls grew 44% since 2018 to more than 1 million last year, according to the Indiana Department of Homeland Security. That comes along with a slight decline in the number of emergency medical technicians and paramedics and an 11% drop in available ambulances for emergency calls during that time.

Patients at small hospitals in rural communities face waiting hours or more for an ambulance ride for more advanced treatment at hospitals in Indianapolis, Cincinnati or Chicago.

“It’s going to lead to worse outcomes,” said Dr. Michael Kaufmann, Indiana’s EMS medical director. “So, higher morbidity and mortality for Hoosiers.”

Rush Memorial Hospital in the small eastern Indiana city of Rushville has tried to hire EMTs to exclusively handle transfers but struggled to fill the open positions, WFYI-FM reported.

“When a patient comes in and needs a higher level of care, it has never up until recently been so scary,” said Carrie Tressler, the hospital’s vice president of nursing.

Kaufmann told a state legislative committee studying Indiana’s trauma care system that low insurance and Medicare reimbursement levels to ambulance services are causing a funding crunch and making it difficult for providers to pay competitive wages.

He said that 50 years ago, the focus was on moving patients quickly, and ambulances were reimbursed as transportation providers rather than health care, The (Fort Wayne) Journal Gazette reported. Now ambulances carry expensive equipment and medicine, and the cost has risen while reimbursement hasn’t kept pace, he said.

Kaufmann presented statistics showing that someone injured in an urban or suburban county in Indiana has an average response time of three minutes and transport time of five minutes. For a rural county, that jumps to 17 and 30 minutes. And if the patient needs to be transported to a trauma center, it can take hours.

Nate Metz, president of the Indiana EMS Association, said lives are at stake.

“There are hospitals in the state right now that are waiting eight, nine, 10 hours to get a transport to take that patient to a higher level of care,” Metz said.

Metz said he was frustrated with the state Legislature’s lack of response to the problem.

“Even our association has been, you know, raising this alarm now for eight years, and no one wants to listen,” Metz said. “Last legislative cycle, we’ve raised this alarm, trying to push legislation to help us. No one wanted to listen, none of it got passed, it all got shut down.”

Copyright 2021 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed without permission.