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Taking action on the shrinking availability of EMS in rural America

NAEMT encourages all states to recognize EMS as an essential service and urges Congress to fund the SIREN Act


NAEMT President Matt Zavadsky discusses how this NBC News coverage highlights the plight of rural communities, and exposes a dilemma for communities in both rural and urban areas, and shares NAEMT positions on lobbying Congress to enact the SIREN Act, and for states to recognize EMS as an essential service. Read more here.


A western-themed mailbox sign is shown at left as a paramedic unit from King County’s Medic One stands by on Twisp River Road in Twisp, Wash.

AP Photo/Ted S. Warren

NAEMT thanks NBC News and Erika Edwards for a comprehensive and insightful article that sheds light on the shrinking availability of EMS in many communities across our country.

As healthcare resources become more scarce, the responsibility for healthcare delivery often falls to America’s safety net healthcare system, local EMS agencies. Many rural EMS agencies rely on volunteers for staffing and responding to ambulance calls. Increasing job responsibilities, training requirements and the changing economic environment have made it more difficult for EMS agencies to recruit and retain volunteers. Many rural agencies have closed.

The article highlights the plight of these rural communities, and exposes a dilemma for communities in both rural and urban areas. As noted in the article, only 11 states deem EMS as an essential service. Most states do not fund EMS as an essential service in the same way that police and fire services are funded. Moreover, payments for EMS care paid by insurance providers, Medicare and Medicaid are usually less than the cost of providing the care. This current economic model for EMS makes it difficult for EMS agencies to compensate EMTs and paramedics based on the value they bring to their patients and local communities, and the nation’s healthcare system. Low pay rates, dangerous work environments and challenging work schedules often discourage people interested in a career in EMS. Many who are in the EMS workforce leave the profession to seek higher compensated positions in other professions.

NAEMT urges all states to recognize EMS as an essential service. We also support meaningful EMS payment reform that will allow both rural and urban EMS agencies to compensate their personnel at a level in which they can sustain an EMS workforce capable of responding to the needs of their communities. NAEMT urges Congress to fund the SIREN Act passed into law in 2018. Once funded, this law will create a grant program for public and non-profit EMS agencies in rural areas, many of which are at the forefront of the opioid epidemic, to support recruitment, retention, education and equipment for EMS personnel specifically in rural areas.

NAEMT position on EMS as an Essential Public Function

Read NAEMT’s position on EMS as an Essential Public Function below:

Matt Zavadsky, MS-HSA, EMT, is the chief transformation officer at MedStar Mobile Healthcare, the exclusive emergency and non-emergency Public Utility Model EMS system for Fort Worth and 14 other cities in North Texas that provides service to 436 square miles and more than 1 million residents and responds to over 170,000 calls a year with a fleet of 65 ambulances. MedStar is a high-performance, high-value Emergency Medical Services system, providing advanced clinical care with high economic efficiency.

MedStar is one of the most well-known EMS agencies in the county, and operates a high-performance system with no tax subsidy, and the recipient of the EMS World/NAEMT Paid EMS system of the Year, and the only agency to be named an EMS10 Innovator by JEMS Magazine.

He is also the co-author of the book “Mobile Integrated Healthcare – Approach to Implementation” published by Jones and Bartlett Publishing.

He has 42 years’ experience in EMS and holds a master’s degree in Health Service Administration with a Graduate Certificate in Health Care Data Management. Matt is a frequent speaker at national conferences and has done consulting in numerous EMS issues, specializing in high-performance EMS operations, finance, mobile integrated healthcare, public/media relations, public policy, transformative economic strategies, and EMS research.

Matt is also immediate past president of the National Association of EMTs, and chairs their EMS Economics Committee.