Rural Policy Research Institute EMS Study

From RUPRI in January 2021

Characteristics and Challenges of Rural Ambulance Agencies – A Brief Review and Policy Considerations

Rural ambulance agencies, a fundamental component of the rural emergency medical services (EMS) system, are challenged by the following issues:

  • long distances and challenging terrain that prolong emergency response and transport times,
  • insufficient payment by insurers to cover standby and fixed costs,
  • a changing workforce that has historically relied on volunteers but increasingly must include paid personnel,
  • a lack of regional EMS plans to coordinate services, and
  • insufficient State and Federal policy coordination across oversight agencies.

Specific public policies to address rural ambulance agency challenges could include the following:

  • Increase ambulance payment to adequately cover reasonable standby and fixed costs.
  • Consider EMS an essential service, the same as firefighting and law enforcement.
  • Collect rural ambulance agency workforce data to better understand workforce needs.
  • Expand the scope and authority of the Federal Interagency Committee on EMS to address rural ambulance agency payment and workforce challenges.

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