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Is rural EMS on life support?

As the number of volunteers dwindles, so does the medical safety net that EMS provides


When you're living in rural America, you expect to live without a lot of services that city folk take for granted – city water, sewers and the like. Even critical services, such as law enforcement and fire protection, can be sparse. It's the price you pay for living in some of the most beautiful parts of the country.

But medical emergencies, such as strokes, heart attacks and cardiac arrest, happen in rural settings, along with critical trauma events, such as high-speed crashes and agricultural incidents. Minutes can make a difference in these situations, regardless of their location and distance to an appropriate medical facility.

It's been known for decades that rural EMS is in critical condition in the United States. Built on the backs of hard working, dedicated volunteers, rural ambulance services have been scraping by to continue to provide emergency response to their communities.

As the number of volunteers dwindles, so does the medical safety net that EMS provides. A recent study by the American College of Emergency Physicians verifies that trend – a rural EMS response may take almost twice as long as an urban response.

EMS funding cuts threaten services

It's not only the loss of volunteer EMS providers creating a service gap. Funding for EMS overall has always been tight. Reimbursement for rural transport can be higher than for urban transport, but not enough to reliably make ends meet. Recently, funding cuts to a North Dakota's ambulance service are pushing it to the brink.

EMS is a health service, regardless of where and how it is provided. I'm guessing that most Americans believe that if they need urgent medical response and transport, that an ambulance will be sent to their location no matter where they live. It would likely come as a shock to realize that nothing could be further from the truth in rural America.

Rural field care is not the only health service at risk of collapse. Rural hospitals have been closing around the country, and nearly a third of the remaining facilities are vulnerable to closure, according to the National Rural Health Association. The NHRA predicts that nearly 11 million citizens will lose access to direct health care if cuts to funding continue.

Solutions are not easy to come by. EMS systems will likely need to consolidate. Career staffing at a regional level that provides not only 911 response but also community health services, such as discharge care, prevention, surveillance and referral is likely the model of the future. But that supposition is predicated on health care reimbursement models that focus on improving patient outcomes, not simply fee for service.

Meanwhile, rural EMS continues to hemorrhage. How long will it be before rural communities are irreparably harmed, is anyone's guess. I can only hope that policy makers can make enough changes to keep EMS from going flat line.

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