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Home > Topics > EMS Management
August 26, 2014
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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 Editor in Chief 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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