Trending Topics

State EMS directors discuss hot topics in rural EMS

The significant funding, workforce and leadership challenges facing rural EMS agencies were discussed at National Rural EMS Conference


Panelists Jay Bradshaw (standing), Joe Schmider, Andy Gienapp and Tom Nehring discuss challenges facing rural EMS.

SAN ANTONIO — Four state EMS directors shared the stage at the National Rural EMS Conference to discuss some of the more unique and pressing issues that rural EMS agencies are facing in the United States.

  • Jay Bradshaw, retired Director of Maine EMS
  • Joe Schmider, Texas State EMS Director
  • Andy Gienapp, Manager of the Wyoming Office of Emergency Medical Services
  • Tom Nehring, Director of the North Dakota Division of Emergency Medical Services and Trauma

The Recognition of EMS Personnel Licensure Interstate CompAct is model legislation written by the National Association of State EMS Officials that would allow EMTs and paramedics to have one license that is recognized by all states that have signed the compact. REPLICA would support providers that practice across state lines, a situation many urban providers never need to consider, but one that would help some rural communities gain access to a wider array of providers.

When asked what advice they would give to rural EMS leaders the panel recognized that individuals running these agencies are balancing more than their fair share; often working full-time, being there for their family, all while managing their respective organizations. They recognized that rural EMS was created to fill a gap in care, and that this gap has only continued to grow, leading to a greater reliance on rural EMS with a shrinking level of support.

When someone in the audience asked about lowering educational standards to allow for a greater number of applicants, the panel shut down that logic immediately. Nehring recognized that this was a tempting solution to current problems, but reiterated that for EMS to move forward as a profession, “going backwards would be a big mistake.” The panelists also made sure to advocate for increased educational opportunities for leaders on the non-clinical components of running an EMS organization.

After the panel Nehring and Gienapp reiterated that rural EMS has the capacity to bring lessons learned to the national conversation, and that the experiences of rural agencies could serve as learning opportunities for their urban counterparts. They also shone a light on the increasing number of hospital closures in rural areas, something of an underutilized window of opportunity for rural EMS leaders.

Memorable quotes on rural EMS
“It’s about funding, it’s about workforce, and it’s about leadership that doesn’t know how to get the first two.”
– Andy Gienapp

“Stop trying to be an island within ourselves … it’s a community approach.”
– Joe Schmider

“The more complex EMS becomes, the more competent leadership has to become.”
–Jack Stout, attributed

Key takeaways
Here are three key takeaways from the panel discussion:

  • Rural EMS faces many barriers to success that their urban counterparts never need to consider, but they also exist in environments that have less of an issue with bureaucracy and red tape.
  • Legislative changes such as REPLICA can be a big step forward for the industry.
  • Solutions must be found that allow for the industry to remain solvent, without lowering any educational or hiring standards.

Catherine R. Counts, PHD, MHA, is a health services researcher with Seattle Medic One in the Division of Emergency Medicine at the University of Washington School of Medicine. She received both her PhD and MHA from Tulane University School of Public Health and Tropical Medicine.

Dr. Counts has research interests in domestic healthcare policy, quality, patient safety, organizational theory and culture, and pre-hospital emergency medicine. She is a member of the National Association of EMS Physicians and AcademyHealth. In her free time she trains Bruno, her USAR canine.

Connect with her on Twitter, Facebook, or her website, or reach out via email at