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EMS News in Focus
by Arthur Hsieh

What do Rural Metro layoffs mean for the rest of EMS?

It may be that local communities will need to band together to create regional EMS systems that are supported by a combination of taxes, reimbursement and private pay

By Arthur Hsieh

A year ago, one the of the nation’s largest providers of EMS and medical transportation filed for bankruptcy. At that time I was worried about the long-term implications for not only its employees, but also for the health of the communities that the agency serviced.

In the year since, Rural Metro has been scaling back operations in their underperforming service areas, which now includes Indiana. This will leave many communities facing hard decisions about who will provide emergency service.

If the economies of scale — which a large corporation touts as an organizational strength — doesn’t result in a sustainable model, what implications does it have for smaller agencies?

It may be that local communities will need to band together to create regional EMS systems that are supported by a combination of taxes, reimbursement and private pay. Such systems will also need to provide more than 911 service; integration with local health resources will be essential.  

Perhaps most importantly, community leaders will need to really understand the intricacies of our fragile health care system and become staunch advocates of systems that are proactive in meeting the challenging environment, not just replacing what’s there. Otherwise, there is no doubt in my mind that any replacement system will simply collapse over time.

While there is a positive sea change in the direction of field care services happening, I am becoming increasingly concerned that there is an undercurrent of potentially disastrous consequences lurking beneath the surface. Like a tsunami emanating from an undersea earthquake, we may not see its effects until the last possible moment, when it is too late to react.

In our case, the severe underfunding of emergency ambulance service through declining health care reimbursement and shrinking tax bases may force a major restructure of EMS as we know it. And, there will be casualties among us. It’s happening already.

About the author

EMS1 Editorial Advisor Art Hsieh, MA, NREMT-P currently teaches at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. Since 1982, Art has worked as a line medic and chief officer in the private, third service and fire-based EMS. He has directed both primary and EMS continuing education programs. Art is a textbook author, has presented at conferences nationwide, and continues to provide patient care at an EMS service in Northern California. Contact Art at
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Brian Mast Brian Mast Tuesday, August 26, 2014 3:19:39 PM EMS in general seems to be the ugly stepchild of the healthcare landscape. Unfortunately I don't see things changing for the better until we as a profession wake up and demand changes, not only in the area of reimbursements but also by turning paramedicine into a two year degree with the option of a bachelors degree. I hope I am wrong, but I see a rocky road ahead for EMS.
Therle Dregansky Therle Dregansky Tuesday, August 26, 2014 5:33:26 PM Brian, paramedicine has been a two year degree for years. The pay scale can't be increased to reflect the degree because the field is inundated by insurance games that prevent companies from providing quality care in return for fair compensation. The insurance mess is a double-whammy for the EMS industry, because we are hit by it twice. First, we have to fund for it, and then we have to suffer by it.
Kg Lockwood Kg Lockwood Wednesday, August 27, 2014 6:26:19 AM Therle, FYI: there still are many places that do NOT require any degree for paramedicine.
Brian Mast Brian Mast Wednesday, August 27, 2014 7:11:49 AM Therle, The state I practice in is slowly moving toward a two year degree. However, it is an uphill battle because of all the volunteer services. I can see their issue ( I was and still am part of a volunteer service. Along with my full time medic job.) A change to a degree program would be the death of almost all, if not all volunteer services. Until we as a country see the need for a nationwide standard of care with better federal and state funding. Rural people are reliant on an antiquated system that works, but is on death's door because of the lack volunteers.
Michael T. Long Michael T. Long Thursday, August 28, 2014 9:28:13 AM This is also somewhat due to the fact that Rural/Metro is a for-profit company; especially coming out of bankruptcy, that means areas that don't turn a profit can't continue to be operated. It's multi-factorial; speaking in broad generalities, some municipalities have conditions in their contract that are very hard if not impossible to meet in the best of times, to say nothing of the current reimbursement climate. Then there's the declining reimbursement in general. Then there's the dog-eat-dog world of private EMS, to say nothing of the profit vs. nonprofit and private vs. fire issues. And ultimately who loses? The patients who find themselves with no providers, or subpar providers which I would argue may be even worse. Like Dickens said, it's the best of times, it's the worst of times.

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