Related GuideYou may also want to see this guide on related topic: Trauma
Introduction
Emergency medical services comprise a system of care for victims of sudden and serious injury or illness. EMS plays a crucial health care role in rural and frontier areas. It is estimated that the average U.S. citizen will require the services of an ambulance at least twice in the course of their lives. Thus, the development of effective EMS systems is crucial to the health care of rural Americans.
There are substantial challenges within the rural EMS system, including: high costs for providing EMS care to sparsely populated regions; fewer tax dollars to fund health programs; trouble with providing public services and adapting to change; and difficulties in maintaining private emergency medical services due to low patient volume. In addition, rural regions have difficulties with increasing health care demands from aging residents, organizational instability, poor access to training and medical supervision, volunteer shortages, high response times, lower levels of training, dated equipment, inadequate insurance reimbursement for services, and insufficient public access and communications systems.
Rural EMS is highly dependent upon volunteer personnel. Few small communities have paid EMS services. Many volunteer personnel work full-time in non-EMS related vocations within the community. Some employers are not supportive of employees taking time from work to be involved in emergency care provision or training. Volunteer EMS personnel donate their personal time to provide prehospital care and are usually expected to be available 24 hours a day, and on weekends and holidays.
Sources:
Institute of Medicine. Future of Emergency Care Series: Emergency Medical Services: At the Crossroads. (2006)
Institute of Medicine. (2005). Quality through collaboration: The future of rural health. Washington, DC: The National Academies Press.
McGinnis, L. (2004). Rural and frontier emergency medical services: Agenda for the future. Kansas City, MO: National Rural Health Association.
Emergency Medical Services Overview, University of North Dakota Center for Rural Health
Frequently Asked Questions
Tools
Eligible ZIP Codes for Enhanced Medicare Rural Ambulance and Lab Reimbursement
Other
List of ZIP Codes eligible for the Medicare "Super Rural Bonus" of 22.6% for ambulance trips originating in certain low population density counties and census tracts. Small rural hospitals with less than 50 beds that are located in the ZIP codes eligible for the rural ambulance bonus are eligible for cost-based reimbursement for outpatient labs. Ambulance and lab reimbursement effective as of July 1, 2004. Excel file, with each state listed on a separate worksheet. Click your state at the bottom.
Emergency Medical Services for Children
Database
Contains listings of publications, funding opportunities, state and national activities, research, publications, education and training plus more. Also includes the National EMSC Data Analysis Resource Center.
EMS Responder.com
Web site
Provides news, education opportunities, events, training, optional membership, and more regarding EMS services.
EMS.gov
Web site
Contains news, functions as a portal to other EMS Web sites and resources, and contains background and updates on Federal initiatives and programs.
Farm Rescue and EMS: A State by State Directory
Web site
State-by-state list of farm rescue or response programs, Cooperative Extension Safety Specialists, and State EMS Training Coordinators.
Geriatric Education for Emergency Medical Services
Web site
Curriculum designed specifically to help EMS providers address all of the special needs of the older population.
HIPAA Privacy Rule: Disclosures for Emergency Preparedness - A Decision Tool
Web site
Presents avenues of information flow that could apply to emergency preparedness activities. A guide in determining how the Privacy Rule applies to the disclosure in question, this tool focuses on the source of the information being disclosed, to whom the information is being disclosed, and the purpose of the information being disclosed.
National Highway Traffic Safety Administration Office of Emergency Medical Services
Database
Develops and enhances comprehensive emergency medical service systems to care for the injured patients involved in motor vehicle crashes.
National Rural EMS Infrastructure Study
Web site
Describes a project of cataloging the location of all Emergency Medical Services in the United States.
Rural Ambulance Service Budget Model
Web site
Provides an overview and instructions for using the Rural Ambulance Service Budget Model, a budgeting and financial management tool for rural ambulance services and rescue squads. Call 866-587-6370 or e-mail info@remsttac.org to receive a copy of the associated .xls file.
Rural Health Research: Emergency medical services (EMS)
Web site
Provides summaries of current and completed rural health research projects and related publications addressing the topic of emergency medical services (EMS), produced by the Office of Rural Health Policy's funded rural health research centers.
Rural Medics
Web site
Contains up-to-the-minute EMS related news as well as a discussion forum. Offers resources and information in many areas for the rural responder.
State EMS Contacts
Web site
Contains a list of state EMS contacts.
State FLEX Programs Tools and Resources: Emergency Medical Services (EMS)
Web site
Lists EMS in the FLEX Program 2008-2010 tools. Lists State Flex Program EMS initiatives such as needs assessment, training, recruitment & retention, and addressing funding/reimbursement.
WISER: Wireless Information System for Emergency Responders
Web site
Assists first responders in hazardous material incidents. Provides information on hazardous substances, including substance identification support, physical characteristics, human health information, and containment and suppression advice.
Maps & Map Collections
Map Tool to Assess Timely Access to Trauma Centers
Interactive
Geographic coverage: United States
Depicts Level I/II trauma center coverage throughout the United States. Identifies the availability of helicopter or ambulance for transport method.
Date: 2005
Regulations, Forms & Other Useful Documents
2005 National Consensus Meeting on EMS Clinical Performance Indicators
Sponsoring organization: North Central EMS Cooperative
Overview of a meeting held in June 2005 to form the EMS industry's pilot set of clinical performance indicators. The meeting was hosted by the North Central EMS Institute and its partners, the National Rural Health Resource
Center, the Rural EMS & Trauma Technical Assistance Center, the National EMS Management
Association and the American Ambulance Association.
Date: 02 / 2006
Access to Emergency Medical Services in Rural Areas: The Supporting Role of State EMS Agencies
Author(s): Astrid Knott
Sponsoring organization: University of Minnesota Rural Health Research Center
Reports on a survey of state EMS directors regarding access to rural EMS, programs and initiatives by state EMS agencies that target rural and volunteer EMS providers, integration initiatives by rural EMS providers, issues in medical direction for rural EMS, and anticipated effects of the new Medicare fee schedule on rural EMS providers.
Date: 02 / 2002
Alternative Approach to Defining Rural for the Purpose of Providing Emergency Medical Services (EMS)
Sponsoring organization: Rural Health Resource Center Technical Assistance and Services Center
Defines rural and access appropriately for emergency medical services. Includes maps.
Date: 07 / 2004
Ambulance Providers: Costs and Expected Medicare Margins Vary Greatly
Sponsoring organization: Government Accountability Office
Examines the differences in providers' costs of ambulance transports in 2004 and factors that contributed to these differences. Includes information for urban, rural and super-rural areas.
Date: 05 / 2007
Ambulance Services: Medicare Payments Can be Better Targeted to Trips in Less Densely Populated Rural Areas
Sponsoring organization: Government Accountability Office
Covers factors that affect ambulance costs
per trip, how these factors vary across geographic areas, and how well Medicare payments account for geographic cost differences.
Date: 09 / 2003
Around the Country: EMS Co-op Helps Rural Providers
Author(s): Candi Helseth
Sponsoring organization: Rural Assistance Center
Highlights the North Central EMS Cooperative (NCEMSC), a Minnesota-based, EMS co-op that provides a mechanism to achieve cost reductions for members.
Journal citation: Rural Monitor
Date: 08 / 2007
Around the Country: MEDLearn: Fake Patient Teaches Real Medicine
Author(s): Candi Helseth
Sponsoring organization: Rural Assistance Center
Describes a human patient simulator offered for hands-on practice by Montana Health Network's Montana Mobile Education Delivery and Learning (MEDLearn) Program.
Journal citation: Rural Monitor
Date: 2007
Around the Country: U.S. Pacific Islands Helping Hearts
Author(s): Hope Hanson
Sponsoring organization: Rural Assistance Center
Highlights the CDC's Pacific Emergency Health
Initiative which provides training as well as AEDs to U.S. Pacific Islanders.
Journal citation: Rural Monitor
Date: 06 / 2006
Around the Country: Washington EMS Live @ Night
Author(s): Hope Hanson
Sponsoring organization: Rural Assistance Center
Discusses an interactive video conferencing program whose purpose is to educate volunteer emergency medical services personnel who don't have access to training sites.
Journal citation: Rural Monitor
Date: 11 / 2005
Becoming an Emergency Medical Technician: Urban-Rural Differences in Motivation and Job Satisfaction
Author(s): P. Daniel Patterson, Victoria A Freeman, Charity G. Moore, Rebecca T. Slifkin
Sponsoring organization: North Carolina Rural Health Research and Policy Analysis Center (Cecil G. Sheps Center)
This study uses cross-sectional data from the 2003 national Longitudinal Emergency
Medical Technician Attributes and Demographic Study (LEADS) Project to explore urban-rural
differences in why EMTs enter the field, what is important in their jobs, and whether they are
satisfied with their profession.
Date: 03 / 2007
Characteristics of Frequent Emergency Department Users
Author(s): Elizabeth M. Peppe, Jim W. Mays, Holen C. Chang, Eric Becker, Bianca DiJulio
Sponsoring organization: Kaiser Family Foundation
Examines the demographic and health characteristics of people who frequently use hospital Emergency Departments (ED) and how the risk of being a High ED User varies based on these characteristics.
Date: 09 / 2007
Community-Based Needs Assessment: Assisting Communities in Building a Stronger EMS System
Sponsoring organization: Office of Rural Health Policy
Outlines a community planning process for rural EMS systems that that engages local stakeholders to facilitate appropriate planning and decision making at the local level.
Date: 2007
Distance Education in EMS: A Literature Review and Rural/Urban Comparison
Sponsoring organization: Office of Rural Health Policy
Explores what is known about distance learning in EMS and how distance learning is being used to provide continuing education to EMS professionals in rural and urban areas. Includes recommendations for future development and application.
Date: 2007
Emergency Medical Service Volunteer Personnel in Nebraska: Workforce of the Present, Hope for the Future?
Author(s): Fred Ullrich, Keith Mueller, Michael Shambaugh-Miller
Sponsoring organization: Nebraska Center for Rural Health Research
Discusses survey of rural Nebraska emergency services providers regarding use of volunteers to provide EMS services. Includes information on why people volunteer, benefits provided to volunteers, and recruitment.
Date: 12 / 2004
Emergency Medical Services (EMS) Activities Funded by the Medicare Rural Hospital Flexibility Program
Sponsoring organization: Flex Monitoring Team
Describes the EMS-related projects that states proposed to conduct in fiscal year 2004-
2005 as part of the Medicare Rural Hospital Flexibility Program.
Date: 02 / 2006
Emergency Medical Services in Frontier Areas: Volunteer Community Organizations
Sponsoring organization: National Center for Frontier Communities
Provides information on paid and volunteer Emergency Medical Services (EMS) workers in frontier and rural areas. Discusses challenges facing volunteer EMS systems and provides examples of different types of programs from several states.
Date: 04 / 2006
Emergency Medical Services in Rural Areas: How Can States Ensure Their Effectiveness?
Author(s): Tim Henderson, Jerry Coopey
Sponsoring organization: National Conference of State Legislatures
Discusses challenges in providing Emergency Medical Services (EMS) in rural areas and methods state governments can use to improve rural EMS.
Journal citation: NCSL Rural Health Brief
Date: 08 / 2000
EMS Education Agenda for the Future: A Systems Approach
Sponsoring organization: National Highway Traffic Safety Administration
Contains a vision for an education system that promises improved efficiency for the national EMS education process, enhanced consistency in education quality, and ultimately, greater entry-level student competence.
Date: 06 / 2000
EMSC Five-year Plan: 2001-2005
Sponsoring organization: U.S. Department of Health and Human Services
Serves as a National blueprint for those charged with ensuring the futures of our Nation's children. Includes numerous goals and objectives.
Date: 2000
Equipment for Ambulances
Sponsoring organization: American College of Emergency Physicians
Provides a list of standardized equipment for ambulances to optimize prehospital delivery of care and includes resources needed for appropriate terrorism preparedness.
Date: 2006
Future of Emergency Care Series: Emergency Care for Children: Growing Pains
Sponsoring organization: Institute of Medicine
Part two in a series of three reports from the Committee on the Future of Emergency Care in the United States Health System. Examines pediatric emergency and trauma care. This report is also a follow-up to the 1993 IOM report Emergency Medical Services for Children.
Date: 2006
Future of Emergency Care Series: Emergency Medical Services: At the Crossroads
Sponsoring organization: Institute of Medicine
Part one in a series of three reports from the Committee on the Future of Emergency Care in the United States Health System. Examines prehospital EMS services.
Date: 2006
Future of Emergency Care Series: Hospital-Based Emergency Care: At the Breaking Point
Sponsoring organization: Institute of Medicine
Part three in a series of three reports from the Committee on the Future of Emergency Care in the United States Health System. Examines hospital-based emergency and trauma care.
Date: 2006
Future of Emergency Care: Dissemination Workshop Series
Sponsoring organization: Institute of Medicine
Summarizes the proceedings of three one-day regional dissemination workshops, conducted in Salt Lake City, UT; Chicago, IL; and New Orleans, LA. Topics include pediatric emergency care and care in rural areas; workforce issues and hospital efficiency; and EMS issues and disaster preparedness.
Date: 2007
Future of EMS in Canada: Defining the New Road Ahead
Sponsoring organization: International Roundtable on Community Paramedicine
Presents the strategic policy framework to provide Canadians with in-patient care today and into the future. Calls for the fulfillment of six strategies.
Date: 09 / 2006
Guide for Enhancing Rural Emergency Medical Services
Sponsoring organization: Transportation Research Board
Guidance for implementation of the AASHTO Strategic Highway Safety Plan. Provides strategies that can be employed to enhance rural emergency medical services.
Date: 2005
Improved EMS Delivery can Reduce Fatalities on Rural Roads
Sponsoring organization: National Cooperative Highway Research Program
One of a series of guides to help states improve rural highway safety.
Investigating Rural Emergency Medical Service (EMS) Infrastructure (Executive Summary)
Author(s): P. Daniel Patterson, Janice C. Probst, Charity G. Moore
Sponsoring organization: South Carolina Rural Health Research Center
Explores a potential indicator of EMS availability, Expected Annual Emergency Miles per Ambulance (EXAMB). The ambulance is used as the core unit of availability due to its importance for safe transport and the initiation of medical services.
Date: 08 / 2004
Model Trauma System: Planning and Evaluation
Sponsoring organization: Health Resources and Services Administration
A guide to modern statewide trauma system development. It modernizes the HRSA 1992 Model Trauma Care System Plan. The document is designed to provide trauma care professionals, public health officials, and health care policy experts with the direction to use the public health approach, a scientifically proven method, when developing and evaluating trauma systems.
Date: 02 / 2006
Quality Through Collaboration: The Future of Rural & Frontier EMS in the U.S. Health System
Sponsoring organization: Health Resources and Services Administration
Compares the findings of the Institute of Medicine's Future of Emergency Care reports with previous work on Rural Health and with the Rural and Frontier EMS Agenda for the Future and HRSA Model Trauma System Planning and Evaluation document. Identifies similarities and overlaps of the recommendations and approaches.
Date: 2007
Quality Through Collaboration: The Future of Rural Health Care (Full Report)
Sponsoring organization: Institute of Medicine
Examines the quality of health care in rural America. Includes recommendations to improve health care quality and safety in rural communities. Addresses workforce, information technology, finance and other factors that impact rural health care quality.
Date: 11 / 2004
Rural Access to Emergency Services (RAES) Act of 2005
Sponsoring organization: U.S. Senate
An Act, introduced into Congress that would take important steps to improve access to rural EMS services, while ensuring quality care.
Date: 05 / 2005
Rural Ambulance Crashes Literature Review
Sponsoring organization: Office of Rural Health Policy
A review of the published research pertaining to ambulance crashes with a special emphasis on the rural environment. Provides an overview of the magnitude of the risk that rural ambulance operators face every time they respond to an illness or injury. Includes citations to the literature, with annotations.
Date: 2007
Rural and Frontier EMS Agenda for the Future: A Service Chief's Guide to Creating Community Support of Excellence in EMS
Sponsoring organization: Office of Rural Health Policy
Identifies practical ideas that can be applied in almost any rural and frontier EMS agency to support rural EMS services. A companion document to the 2004 report, the Rural and Frontier EMS Agenda for the Future.
Date: 2007
Rural and Frontier EMS Town Hall Meeting Summary
Sponsoring organization: Health Resources and Services Administration
Highlights several town hall meetings that were conducted by HRSA's REMSTTAC during which rural EMS providers identified various issues of interest and concern to their local agency.
Date: 2007
Rural Emergency Department Staffing: Potential Implications for the Quality of Emergency Care Provided in Rural Areas
Sponsoring organization: Upper Midwest Rural Health Research Center
Reports results of a study of rural emergency department staffing and discusses potential
implications of staffing for the quality of emergency care provided in rural areas.
Date: 08 / 2007
Rural Emergency Medical Service (EMS) Infrastructure
Sponsoring organization: South Carolina Rural Health Research Center
Prehospital care has become an important element in the spectrum of health services. Approaches for comparing the availability of Emergency Medical Service (EMS) across communities are a first step in developing policies that ensure equitable access for rural and frontier communities.
Date: 2004
Rural EMS Managers Awareness Program
Sponsoring organization: Office of Rural Health Policy
Guide to provide new emergency medical services (EMS) agency managers with an
orientation to the broad scope of an EMS system. Includes background information and covers 14 components of the EMS system.
Date: 2007
Trauma Systems Save Rural Lives
Author(s): Candi Helseth
Sponsoring organization: Rural Assistance Center
Discusses organized trauma care systems, which are critical to reducing mortality and morbidity in rural areas. Highlights include how access to trauma care varies by state, how rural hospitals play a role in trauma care, and a future goal of having coordinated care nationwide.
Journal citation: Rural Monitor
Date: 11 / 2007
Organizations
American Ambulance Association (AAA)
National organization
Promotes health care policies that ensure excellence in the ambulance services industry and provides research, education, and communications programs to enable its members to effectively address the needs of the communities they serve.
American College of Emergency Physicians (ACEP)
Nonprofit/Foundation
Represents physicians who practice emergency medicine. Provides a national report card that includes an assessment of the support that each state provides for its emergency medicine system.
Angel Flight West
Nonprofit/Foundation
Provides free non-emergency air transportation to medical treatment for people who cannot afford public transportation, or who cannot tolerate it for health reasons. Available only in Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming. For longer flights or flights originating in other regions, go to the Angel Flight America National Patient Travel Center Web Site.
Center for Rural Emergency Medicine (CREM)
National organization
Focuses on research and training for the prevention of illness and injury, the preparedness of emergency providers, and the quality of emergency care in rural areas.
Commission on Accreditation of Ambulance Services (CAAS)
National organization
Encourages and promotes quality patient care in America's medical transportation system. Sponsored by the American Ambulance Association, American College of Emergency Physicians, National Association of EMS Physicians, National Association of State EMS Officials, National Association of EMTs, and International Association of Fire Chiefs, with liaison representation from The National Highway Transportation Safety Administration.
Commission on Accreditation of Medical Transport Systems (CAMTS)
National organization
Provides the highest possible quality to professionals involved with air medical services and ground interfacility transport services, giving priority to patient care and safety of the transport environment.
Critical Illness and Trauma Foundation (CIT)
Nonprofit/Foundation
Focuses on improving outcomes for people who become suddenly ill or who are injured in rural areas of the U.S. and around the world. Dedicated to the prevention of injury and illness, research into rural injury and illness and training for rural emergency medical care providers.
EMS Grant Central Station
National organization
Posts EMS grant opportunities in a variety of states, as well as resource material.
Federal Emergency Management Agency (FEMA)
Federal government
Responsible for responding to, planning for, recovering from and mitigating against disasters. Part of the U.S. Department of Homeland Security.
International Roundtable on Community Paramedicine (IRCP)
International organization
Comprised of delegates from various countries and regions dedicated to exploring the promotion and better delivery of health care through the utilization of traditional and non-traditional models of care.
National Association of EMS Educators (NAEMSE)
National organization
Promotes EMS Education, develops and delivers educational resources, and advocates research and life long learning.
National Association of EMS Physicians (NAEMSP)
National organization
Consists of physicians and other professionals partnering to provide leadership and foster excellence in out-of-hospital emergency medical services.
National Association of EMTs (NAEMT)
National organization
Serves its professional membership through educational programs, liaison activities, development of national standards and reciprocity and the development of programs to benefit pre-hospital care personnel.
National Association of State EMS Officials (NASEMSO)
National organization
Provides leadership and support to develop effective EMS systems throughout the nation and formulate national EMS policy, and to foster communication and sharing among state EMS directors.
National EMS Information System Technical Assistance Center (NEMSIS)
National organization
Offers technical assistance on the implementation and tracking of National EMS Data.
National EMSC Data Analysis Resource Center (NEDARC)
National organization
Helps EMSC grantees and state EMS offices develop their own capabilities to collect, analyze, and utilize EMS and other healthcare data to improve the quality of care in state EMS and trauma systems.
National Highway Traffic Safety Administration Emergency Medical Services Division (NHTSA)
Federal government
Develops and enhances comprehensive emergency medical service systems to care for injured patients involved in motor vehicle crashes.
National Native American EMS Association
National organization
Serves, supports and represents approximately 70 individual Native American Emergency Medical Service programs. These 70 EMS programs provide pre-hospital care to over half a million Native American people who live on reservations or in non-reservation area.
North Central EMS Cooperative (NCEMSC)
National organization
Maintains a network of nearly 1000 EMS agencies in 28 states, east of the Rocky Mountains, all purchasing equipment together on national contracts.
North Central EMS Institute (NCEMSI)
National organization
Provides leadership in EMS through educating, standard setting and benchmarking. Develops benchmarks definitions for the ambulance industry.
Rural Emergency Medical Services & Trauma Technical Assistance Center (REMSTTAC)
Federal government
Serves as a national focal point for the dissemination of information on rural and frontier emergency medical services (EMS) and trauma care. REMSTTAC can be accessed by a broad range of rural and frontier EMS providers including federal grant recipients, state EMS and rural health offices, and their constituencies including rural hospitals and communities.
Rural Health Resource Center Technical Assistance and Services Center (TASC)
National organization
Assists states with all aspects of the Medicare Rural Hospital Flexibility Program (Flex Program), including CAH conversion, networking, EMS and performance improvement. TASC is the technical assistance center for the Flex Program.
U.S. Fire Administration (USFA)
Federal government
Works to reduce fire deaths through data collection, public education, research and training efforts. Part of the U.S. Federal Emergency Management Agency (FEMA).
Western EMS Network (WEMSN)
National organization
Provides rural and frontier EMS agencies in MT, WY, ID, WA, AK, OR, NV, UT, AZ, NM and CA a network which includes purchasing equipment together on national contracts.
Terms & Acronyms
Emergency Medical Services (EMS) Prehospital health care for patients with real or perceived emergencies from the time point of emergency telephone access until arrival and transfer of care to the hospital.
Emergency Medical Technician (EMT) A member of the EMS team who provides out-of-hospital emergency care; includes certifications of EMT-Basic, EMT-Intermediate, and EMT-Paramedic which identify progressively advancing levels of care.
EMS System Any specific arrangement of emergency medical personnel, equipment, and supplies designed to function in a coordinated fashion. May be local, regional, state, or national.
First Responder Initial level of care within an EMS system.
Success Stories
RAC Success Stories: Emergency Services
Electronic Network for the Coordination of EMS Data and Education
The “electronic community” provides ambulance personnel with unrestricted and easy access to state-of-the-art training, communication, and data collection and analysis as well as connections to the State EMS office and other supporting agencies.
First Responder Network
Six remote farming communities in Russell County, Kansas, now have an organized network of trained first responders to provide immediate emergency care in the event of a cardiac arrest. The first responders administer early cardiopulmonary resuscitation (CPR) and defibrillation while the ambulance is on its way.
Southern Iowa Rural Outreach EMS/Trauma Consortium
Activities include the implementation of a uniform EMS training curriculum, triage and trauma treatment protocols, and improved communication among EMS and hospital providers throughout the region.
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