NHTSA | Office of EMS Director Jon Krohmer, MD, to Retire

NHTSA Office of EMS Director Jon Krohmer, MD, to Retire Later this Year

After 15 years of federal service, including the last five leading the National Highway Traffic Safety Administration Office of EMS, Jon Krohmer, MD, will be retiring in November.

During his tenure as director, Dr. Krohmer and the NHTSA Office of EMS team oversaw a number of milestones for the profession, including the creation of EMS Agenda 2050; major revisions to the National EMS Scope of Practice Model and the National EMS Education Standards; and improvements in the collection and use of EMS data through the expansion of the National EMS Information System. Soon after the onset of the coronavirus pandemic, Dr. Krohmer was tapped to lead the prehospital/911 team as part of the Federal Healthcare Resilience Task Force.

“Dr. Krohmer’s tenure at NHTSA—especially over the last year and a half as EMS clinicians have faced one of the greatest public health challenges in generations—has been marked by real advances for the profession, thanks in no small part to his leadership,” said Nanda Srinivasan, NHTSA’s associate administrator for research and program development. “He was a true advocate at the federal level for state, tribal and local EMS systems, EMS clinicians, and patients.”

Prior to joining NHTSA, Dr. Krohmer had decades of experience as a local EMS medical director, initially in his home state of Michigan. His EMS career began as an EMT with a volunteer rescue squad. Like many EMS professionals, he was inspired by the television show Emergency! and by the emergence of the relatively new field of emergency medicine. He entered medical school at the University of Michigan knowing he wanted to make EMS his career. After becoming involved in EMS at the state and national level, he also served as president of the National Association of EMS Physicians from 1998 to 2000. In 2006, he came to Washington to serve as the first deputy chief medical officer for the Department of Homeland Security Office of Health Affairs and served in several other DHS roles before joining NHTSA in 2016.

“Working alongside EMS clinicians and the people who support them at local, state and national levels has been a privilege and a heck of a lot of fun,” said Dr. Krohmer. “The decision to leave NHTSA was difficult, but it’s made easier knowing that the team in the Office of EMS, our colleagues throughout the federal government, and leaders of EMS at state and local levels are committed to improving the lives of people in their communities and will continue to advance EMS systems everywhere.”

NHTSA will launch a national search for a new director for the Office of EMS.

“The example set by Dr. Krohmer will serve as a great model for the next director,” said Associate Administrator Srinivasan, “and the team of dedicated public servants at the Office of EMS has the experience and expertise to ensure a smooth transition.”

Preliminary Calculation of 2022 Ambulance Inflation Update

Section 1834(l)(3)(B) of the Social Security Act mandates that the Medicare Ambulance Fee Schedule be updated each year to reflect inflation.  This update is referred to as the “Ambulance Inflation Factor” or “AIF”.

The AIF is calculated by measuring the increase in the consumer price index for all urban consumers (CPI-U) for the 12-month period ending with June of the previous year.  Starting in calendar year 2011, the change in the CPI-U is now reduced by a so-called “productivity adjustment”, which is equal to the 10-year moving average of changes in the economy-wide private nonfarm business multi-factor productivity index (MFP).  The MFP reduction may result in a negative AIF for any calendar year.  The resulting AIF is then added to the conversion factor used to calculate Medicare payments under the Ambulance Fee Schedule.

For the 12-month period ending in June 2021, the federal Bureau of Labor Statistics (BLS) has calculated that the CPI-U has increased by 5.39%.

CMS has yet to release its estimate for the MFP in calendar year 2022.  However, assuming CMS’ projections for the MFP are similar to last year’s projections, the number is likely to be in the 0.4% range.

Accordingly, the AAA is currently projecting that the 2022 Ambulance Inflation Factor will be approximately 5.0%. 

Cautionary Note Regarding these Estimates

Members should be advised that the BLS’ calculations of the CPI-U are preliminary, and may be subject to later adjustment.  The AAA further cautions members that CMS has not officially announced the MFP for CY 2022.  Therefore, it is possible that these numbers may change.  The AAA will notify members once CMS issues a transmittal setting forth the official 2022 Ambulance Inflation Factor.

Letter to Senate HELP Committee Leadership on Provider-Type Equity

The Honorable Patty Murray
Chair, United States Senate Committee on Health, Education, Labor and Pensions

The Honorable Richard Burr
Ranking Member
United States Senate Committee on Health, Education, Labor and Pensions

Dear Chairwoman Murray and Ranking Member Burr:

The American Ambulance Association (AAA) appreciates the opportunity to provide suggestions for bipartisan legislation to improve medical preparedness and response programs. The AAA is the primary association for ground ambulance service suppliers/providers, including governmental entities, volunteer services, private for-profit, private not-for-profit, and hospital-based ambulance services. Our members provide emergency and non-emergency medical transportation services to more than 75 percent of the U.S. population. AAA members serve patients in all 50 states and provide services in urban, rural, and super-rural areas. As the National Highway Transportation Safety Administration identified in its 2013 report on emergency services, EMS-only systems – such as our members – provide the vast majority of emergency ambulance services throughout America.

Our members are often the first health care teams to encounter patients who are sick and/or suspect they might have COVID-19. In addition to responding to 911 emergencies and transporting patients to appropriate destinations, they are also being asked to provide health care services within their existing State-defined scope of practice without transporting patients to help reduce hospital surge, as well as to protect high-risk patients from potential exposure to COVID-19. State and Local governments and public health authorities are also enlisting ground ambulance organizations to assist with testing suspected COVID-19 patients. In addition, ground ambulances provide important medical transitional care for patients moving between facilities in both emergency and non-emergency situations.

During this pandemic, our members have experienced first-hand the gaps in the public health infrastructure and the medical preparedness and response systems and programs. One of the most frustrating aspects of the current system has been the lack of recognition and support for communities that contract with non-governmental ground ambulance providers/suppliers in everything from federal grant programs to the distribution of personal protective equipment for EMTs and paramedics.

Many of the federal grant programs triggered during the pandemic have fallen short of their promise because the statutes and regulations governing them do not recognize non-governmental ground ambulance providers/suppliers as eligible entities. This distinction remains confusing because in other areas of health care, federal grant programs are accessible by private, for-profit health care providers and suppliers.

Outdated statutes and regulations often assume that first responders are governmental or not-for-profit entities and ignore the decisions of State and Local governments to contract with private ground ambulance providers/suppliers to provide 911 or equivalent services. As others have recognized, “State and Local officials know what works best in their communities – what works best in New York City may be much different than what works in rural Tennessee.”1 The federal government should respect these local decisions and support all first responders.

An example of this problem arose early during the COVID-19 pandemic. The FEMA public assistance grant program reimburses first responders for PPE and other expenses related to the response to COVID-19. When public and private non-profit emergency ambulance providers/suppliers sought direct reimbursement under the program, they were turned away. Private emergency ambulance providers/suppliers were required to have a State or Local government agency apply on their behalf. As State and Local governments responded to the public health emergency, it was understandably difficult for them to allocate resources to work through the application process on behalf of their contractors.

This differential treatment impacts communities across the United States, including those in Arkansas, California, Colorado, Florida, Georgia, Indiana, Louisiana, Massachusetts, Mississippi, Nevada, New York, Oregon, Texas, and Wisconsin, among others.

In contrast to statutes like the one government FEMA allocations, the Homeland Security Act of 2002 (6 U.S.C. § 101) includes language that recognizes the decision of State and Local governments to contract with private not-for-profit and for-profit ground ambulance providers/suppliers within the definition of “emergency response providers.”

The AAA urges the Congress to adopt the Homeland Security Act definition of “emergency response providers” throughout the U.S. Code as applicable. Such language will help to make sure that when funding is available to help State and Local governments prepare and respond, the allocation mechanisms governing the funding permit all types of first responders, including non-governmental ground ambulance providers/suppliers, to access the dollars quickly and with minimal burden.

Recommendation

The Committee should carefully review federal public health programs and revise them as necessary to ensure that the funds may be used to support both non-governmental and governmental ground ambulance providers/suppliers to ensure that all communities, regardless of their individual decisions related to the entities operating their EMS systems, have federal funds to support their response efforts during public health emergencies.

On behalf of the AAA, I want to thank you for your ongoing support of EMS and ground ambulance providers/suppliers, as well as the leadership demonstrated by your work to prepare for the next pandemic. Over the years, the Congress has consistently recognized the vital and unique role that ground ambulance providers/suppliers play in protecting their communities and providing mobile health care services. In light of the lessons learned during this pandemic, we encourage you and your colleagues to revise antiquated language that no longer represents the innovations and progress that have led to State and Local governments to rely upon ground ambulance providers/suppliers, including non-governmental organizations.

The AAA and its volunteer leaders would welcome the chance to discuss this recommendation. We would also be pleased to participate in any fact-finding discussion or hearing that the Congress plans to host to better understand how the problems experienced during the current pandemic can be avoided in the future. Please do not hesitate to reach out to Tristan North at (202) 486-4888 or tnorth@ambulance.org, or Kathy Lester at (202) 534-1773 or klester@lesterhealthlaw.com to schedule a time for further discussion.

Sincerely,

Shawn Baird
President, American Ambulance Association
Vice President of Rural Services, Metro West Ambulance

1The Honorable Lamar Alexander, “Preparing for the Next Pandemic” White Paper” 4 (June 9, 2020).

CMS Addresses Substance Use, Mental Health Crisis Care for Those with Medicaid

CMS Addresses Substance Use, Mental Health Crisis Care for Those with Medicaid

$15 Million Funding Opportunity for State Planning Grants to Bolster Mobile Crisis Intervention Services

The Centers for Medicare & Medicaid Services (CMS) announced a funding opportunity made possible by the American Rescue Plan (ARP) to help states strengthen system capacity to provide community-based mobile crisis intervention services for those with Medicaid. The $15 million funding opportunity is available to state Medicaid agencies for planning grants to support developing these programs.

This funding opportunity provides financial resources for state Medicaid agencies to assess community needs and develop programs to bring crisis intervention services directly to individuals experiencing a mental health or substance use related crisis outside a hospital or facility setting. These services may include screening and assessment, stabilization and de-escalation, and coordination of referrals after the initial treatment.

“Investing in crisis intervention services ensures Americans experiencing a mental health or substance use disorder crisis get the care and treatment they need,” said Secretary Becerra. “These grants will help states build these critical services to help communities send a responder who is trained and ready to assist people in crisis.”

“It is vital that we can meet people where they are, especially when those individuals are in crisis,” said CMS Administrator Chiquita Brooks-LaSure. “This funding will help state Medicaid agencies plan innovative ways to provide and better mobilize these essential intervention services to their communities.”

The planning grants provide funding to develop, prepare for, and implement qualifying community-based mobile crisis intervention services under the Medicaid program. Grant funds can be used to support states’ assessments of their current services, strengthen capacity and information systems, ensure that services can be accessed 24 hours a day/365 days a year, provide behavioral health care training for multi-disciplinary teams, or to seek technical assistance to develop State Plan Amendment (SPAs), demonstration applications, and waiver program requests under the Medicaid program.

Letters of Intent to apply from states and territories are due July 23, 2021. Final applications must be submitted by August 13, 2021, 3:00 pm ET. The period of performance for this grant will be from September 30, 2021, through September 29, 2022. The Notice of Funding Opportunity (NOFO) provides additional details regarding eligibility and program requirements, as well as key deadline and application submission information.

To view the NOFO, visit Grants.gov and search for the announcement by CFDA# 93.639.

EMS.gov | New Resources Help EMS Clinicians and Agencies Navigate HIPAA

Nationwide, EMS agencies regularly report that hospitals and other healthcare workers refuse to share patient information with them, citing Health Insurance Portability and Accountability Act (HIPAA) concerns. Misconceptions about HIPAA can create artificial barriers to the legitimate, approved exchange of data between EMS and other providers, resulting in missed opportunities to improve patient outcomes and advance evidence-based practices in prehospital care.

To address this issue, the NEMSIS Technical Assistance Center collaborated with the law firm Page, Wolfberg & Wirth to provide helpful resources explaining the sharing of patient information between EMS and other healthcare professionals:

While obstacles may remain for the appropriate sharing of patient information, HIPAA is not one of them. Sharing patient information benefits EMS agencies and improves prehospital patient care by revealing evidence-based practices that make a difference for patients in the field.

EMS Balance Billing Quick Take—July 7, 2021

Webinar July 7, 2021 | 13:00–13:30 ET | Free to AAA Members
Speakers: Kathy Lester, Esq. & Asbel Montes

On July 1, CMS issued a proposed rule on Surprise Billing which applies to those providers and physicians identified in the No Surprises Act. This statute subjected ground ambulance suppliers to an HHS Advisory Committee process prior to any rulemaking addressing these services.

The consultants and staff of the American Ambulance Association are doing a deep dive into the 400+ page rule and evaluating its nuances. We continue to understand from our conversations that ground ambulances are not included and instead are subjected to the Advisory Committee.

The American Ambulance Association will soon provide a summary to members, and will address any confusion with the Administration. Join AAA for a quick take live webinar on July 7 at 13:00 ET to learn more!

Register Now

 

Webinar 6/30 | OSHA’s New Emergency Temporary Standard

June 30, 2021 | Noon ET | Free to American Ambulance Association Members / $99 List

Register Now

On June 21, 2021, the U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) published its COVID-19 Emergency Temporary Standard (“ETS”), meaning the new regulations are now effective. Covered healthcare employers must comply with most of the requirements of the ETS by July 6, 2021.  These new standards apply to employers subject to OSHA’s jurisdiction, and in all settings where employees provide healthcare or healthcare support services. 

This webinar will analyze the applicability of the ETS to EMS organizations, many of which, EMS employers implemented long before the ETS was issued.  However, these new standards include extensive workplace hazard assessment and documentation requirements that many EMS employers must be able to produce to for regulators.  OSHA has emphasized that healthcare employers, including EMS organizations, are the focus of the department’s enhanced enforcement efforts to ensure compliance with these new standards. We will also discuss how EMS employers can utilize many of the OSHA Sample ETS documents and resources the department has created to assist healthcare employers in complying with this standard.

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CMS | New Medicaid and CHIP Enrollment Snapshot

FOR IMMEDIATE RELEASE
June 21, 2021

Contact: CMS Media Relations
CMS Media Inquiries

New Medicaid and CHIP Enrollment Snapshot Shows Almost 10 million Americans Enrolled in Coverage During the COVID-19 Public Health Emergency

Report Shows Record Medicaid Enrollment and Highlights the Program’s Importance in Preserving Coverage for Millions of Children and Adults Throughout the United States

The Centers for Medicare & Medicaid Services (CMS) released a new Enrollment Trends Snapshot report today showing a record high, over 80 million individuals have health coverage through Medicaid and the Children’s Health Insurance Program (CHIP).  Nearly 9.9 million individuals, a 13.9% increase, enrolled in coverage between February 2020, the month before the public health emergency (PHE) was declared, and January 2021.

Among the 50 states and the District of Columbia, a total of 80,543,351 people were enrolled and receiving full benefits from the Medicaid and CHIP programs by the end of January 2021. In the 50 states that reported total Medicaid child and CHIP enrollment data for January 2021, over 38.3 million children were enrolled in Medicaid and CHIP combined, approximately 50% of the total Medicaid and CHIP enrollment. These numbers highlight the essential role the Medicaid and CHIP programs play in providing quality and needed coverage for millions of vulnerable children and adults. In fact, both programs serve as the largest single source of health coverage in the country.

“The Biden-Harris administration is using every lever to ensure any American needing access to quality health coverage receives it. Now more than ever, people need the peace of mind of knowing that they have health coverage,” said HHS Secretary Xavier Becerra. “This report reminds us what a critical program and rock Medicaid continues to be in giving tens of millions of children and adults access to care. This pandemic taught us that now more than ever, we must work to strengthen Medicaid and make it available whenever and wherever it’s needed using the unprecedented investments Congress provided.”

The increase in total Medicaid and CHIP enrollment is largely attributed to the impact of the COVID-19 PHE, in particular, enactment of section 6008 of the Families First Coronavirus Response Act (FFCRA). FFCRA provides states with a temporary 6.2% payment increase in Federal Medical Assistance Percentage (FMAP) funding.  States qualify for this enhanced funding by adhering to the Maintenance of Effort requirement, which ensures eligible people enrolled in Medicaid stay enrolled and covered during the PHE.

“Medicaid and CHIP serve as a much-needed lifeline for millions of people throughout this country. The increase we are seeing is exactly how Medicaid works: the program steps in to support people and their families when times are tough,” said CMS Administrator Chiquita Brooks-LaSure. “For the parents that may have lost a job or had another life change during the pandemic, having access to coverage for themselves and their kids is life-changing. CMS is committed to ensuring our nation’s marginalized communities and low-income families have the coverage they need.”

To assist states and territories in their response to the COVID-19 PHE, CMS developed numerous strategies to support Medicaid and CHIP programs in times of crisis, including granting states more flexibility in their Medicaid and CHIP operations. Today’s data release also reflects a range of indicators related to key application, eligibility, and enrollment processes from within state Medicaid and CHIP agencies.

The Snapshot is a product of the Centers for Medicare and Medicaid CHIP Services (CMCS) Medicaid and CHIP Coverage Learning Collaborative (MACLC), which monitors Medicaid and CHIP enrollment trends, primarily using the CMS Performance Indicator (PI) data reported to CMS by state Medicaid and CHIP agencies. PI data reflects key Medicaid and CHIP business processes- including applications, renewals, eligibility determinations, and enrollment.

The Enrollment Trends Snapshot, which is released monthly, is available here:  https://www.medicaid.gov/medicaid/program-information/medicaid-chip-enrollment-data/medicaid-and-chip-enrollment-trend-snapshot/index.html

The complete dataset, including data from January 2021, is available on data.Medicaid.gov.

HHS ASPR Project ECHO COVID-19 Clinical Rounds

HHS Office of the Assistant Secretary for Preparedness and Response

  • Peer to Peer Sharing : HHS ASPR, Project ECHO, and the National Emerging Special Pathogens Training and Education Centers (NETEC) together support the COVID-19 Clinical Rounds, peer to peer real-time knowledge sharing sessions among front line clinicians on challenges and successes encountered treating COVID-19.
  • Audience of Multidisciplinary Clinicians: Physicians, nurses, and EMS clinicians participate in the Rounds, which continue to focus on critical care, emergency departments, and EMS.
  • Format of Sessions: Each Clinical Rounds session includes brief presentations from experienced expert clinicians complemented by discussion among expert panelists in response to Q&A from participants.
  • Sharing of Experience, Not Official Guidance: Rounds are intended to be the sharing of clinical experience rather than formal recommendations or guidance.
  • Evolving Clinical Round Topics: Topics of Clinical Rounds evolve to address the dynamic COVID-19 medical response.
  • Continuing Medical Education (CME) Credit: Participants can fill out a short survey and receive 1 hour of Continuing Medical Education credit instantly for each session.

Medicare Ambulance Relief Bill introduced in Senate

Yesterday, Senators Catherine Cortez Masto (D-NV) and Susan Collins (R-ME) introduced the Protecting Access to Ground Ambulance Medical Services Act of 2021 (S. 2037). Senators Cortez Masto and Collins were joined by Senators Debbie Stabenow (D-MI), Bill Cassidy (R-LA), Patrick Leahy (D-VT) and Bernie Sanders (D-VT) as primary cosponsors and leads on the legislation.

S. 2037 is identical to H.R. 2454 by Representatives Terri Sewell (D-AL), Devin Nunes (R-CA), Peter Welch (D-VT) and Markwayne Mullin (R-OK) and would extend the temporary Medicare ground ambulance increases of 2% urban, 3% rural and the super rural bonus payment for five years. The increases are currently scheduled to expire on December 31, 2022. The five-year extension would allow for the increases to remain in place during the two-year delay on ambulance data collection due to the COVID-19 public health emergency, an analysis of the data by MedPAC and subsequent action by the Congress to reform the Medicare ambulance fee schedule.

The legislation would also help ensure that rural zip codes in large urban counties remain rural following geographical changes under the fee schedule as a result of the 2020 census data. The current definition using rural urban commuting areas (RUCA) in Goldsmith Modification areas would be modified for zip codes with 1,000 people or less per square mile would also be rural. Ground ambulance service providers and suppliers could also petition the Centers for Medicare and Medicaid Services (CMS) to make the argument that a specific zip code should be rural. It is vital that this provision be implemented before CMS makes changes from the 2020 census data which will likely occur in 2023.

The AAA has been leading the effort on the legislation with the support of the International Association of Fire Chiefs, International Association of Fire Fighters, National Association of EMTs, National Rural Health Association and the National Volunteer Fire Council.

The AAA will be launching a Call to Action shortly requesting AAA members to ask their Senators to cosponsor S. 2037, and reach out to their Representatives to cosponsor H.R. 2454 if they have not already done so.

We greatly appreciate the leadership of Senators Cortez Masto, Collins, Stabenow, Cassidy, Leahy, and Sanders on this vitally important legislation.

6/16 | Federal Interagency Committee on EMS Virtual Meeting

Federal Interagency Committee on EMS to Hold Virtual Meeting on June 16

FICEMS also recently approved a new strategic plan to guide Federal activities related to EMS through 2025

The Federal Interagency Committee on EMS, which coordinates EMS activities throughout the federal government, will hold its first virtual meeting of 2021 on June 16 at 1 pm ET. Members of the public are invited to watch the webcast. Visit the FICEMS meeting page to learn more and view the agenda, or click below to register now. Anyone wishing to provide public comment can email FICEMS@dot.gov with “FICEMS Feedback” in the subject line. There will also be opportunities to ask questions or submit comments via a chat function during the webcast.

Register Now

New FICEMS Strategic Plan

One of the items on the agenda for the next FICEMS meeting is the new FICEMS Strategic Plan, which is now available on EMS.gov. The plan will guide FICEMS and its efforts to support and advance EMS and 911 services in the Nation over the next five years. The plan outlines seven strategic goals, each with multiple objectives, that will serve as the foundation for the activities of FICEMS and its member agencies.

Read the FICEMS strategic plan and learn more about the committee’s vision for Federal support of state, local, tribal and territorial EMS.

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NEMSIS 2020 Public-Dataset Now Available

From NEMSIS on May 28, 2021

FOR IMMEDIATE RELEASE

NEMSIS 2020 Public-Dataset Now Available

Salt Lake City, Utah, May 11, 2021 – The National Emergency Medical Services Information System Technical
Assistance Center (NEMSIS TAC) today announced the availability of the 2020 Public-Release Research Dataset,
the largest publicly available dataset of emergency medical service activations in the United States. With this
release, NEMSIS aims to improve understanding of, confidence in, and support for EMS data collection and
analysis that will lead to data being utilized more effectively to improve patient care.

“The 2020 dataset is a powerful asset for researchers looking into all manner of conditions that affect different
aspects of EMS service.,” said Dr. N. Clay Mann, Professor in the Department of Pediatrics at the University of
Utah School of Medicine and Principal Investigator for the NEMSIS Technical Assistance Center. “Hopefully, the
information gathered during the COVID-19 pandemic will help give EMS agencies valuable insight on their work
improving EMS services under all sorts of conditions.”

The 2020 Public-Release Research Dataset is a subset of the National EMS Database that is the repository for
EMS data collected from U.S. States and Territories. NEMSIS maintains the national standard for how patient
care information resulting from an emergency 9-1-1 call for medical assistance is collected. The dataset includes
43,488,767 EMS activations submitted by 12,319 EMS agencies servicing 50 states and territories.

Those interested in requesting a copy of the 2020 Public-Release Research Dataset can contact the NEMSIS TAC
and fill out a request form at their website https://nemsis.org/using-ems-data/request-research-data. A
password-protected USB drive containing the dataset, the 2020 NEMSIS Data User Manual, NEMSIS Data
Dictionary v3.4.0, Extended Data Definitions v3.4.0, and sample SAS code file will be sent via postal service.

ABOUT NEMSIS

The National Emergency Medical Services Information System (NEMSIS) is the national health information
exchange and database used to collect and store EMS data from states and territories. NEMSIS is a universal
standard for how patient care information resulting from an emergency 9-1-1 call for medical assistance is
collected. It is a collaborative system to improve patient care through the standardization, aggregation, and
utilization of point-of-care EMS data at a local, state, and national level.
NEMSIS is a program of NHTSA’s Office of EMS and is hosted at the University of Utah.

CNN | Rural ambulance crews are running out of money and volunteers

From CNN on May 22, 2021

Rural ambulance crews are running out of money and volunteers. In some places, the fallout could be nobody responding to a 911 call

America’s rural ambulance services, often sustained by volunteers, are fighting for their survival — a crisis hastened by the impact of Covid-19.

More than one-third of all rural EMS are in danger of closing, according to Alan Morgan, CEO of the National Rural Health Association. “The pandemic has further stretched the resources of our nation’s rural EMS.”

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