Rural Emergency Medical Services (EMS) and Trauma

Emergency medical services (EMS) comprise a system of care for victims of sudden and serious injury or illness. 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 in rural and frontier areas.

Add to the equation Trauma, which occurs in various formats. According to the CDC, trauma accounts for 41 million emergency department visits and 2.3 million hospital admissions each year. Trauma is ranked as the most common cause of death for Americans aged 1-44 (the third-ranked cause overall), with more than 180,000 deaths resulting from trauma injuries.

Rural EMS systems face substantial challenges and it may take EMS and trauma personnel longer to arrive at a scene. Few rural communities have paid EMS personnel, depending instead upon volunteers, who often work full-time in non-EMS related vocations within the community, yet continue to donate their personal time to provide pre-hospital care and receive training. Sparsely populated regions lead to higher costs for EMS care, but there are fewer tax dollars to fund EMS programs. Rural populations are aging, which places an increased demand on EMS. Patients may have to be transferred to larger hospitals or trauma centers and arranging these transfers take time.

Additionally, poor access to training and medical supervision, higher response times, dated equipment, inadequate insurance reimbursement for services, and insufficient communications systems all combine to make rural EMS an area of critical concern.

Sources: Trauma Statistics, National Trauma Institute, 2014; Future of Emergency Care Series: Emergency Medical Services: At the Crossroads, 2006; Quality Through Collaboration: The Future of Rural Health, 2005; Rural and Frontier Emergency Medical Services: Agenda for the Future, National Rural Health Association


For technical assistance
American College of Surgeons Trauma Programs

For information about the Rural Trauma Team Development Course (RTTDC)
The American College of Surgeons (ACS)
Telephone: 312.202.5015

There are more organizations related to Emergency Medical Services and Trauma in the organizations section.

Frequently Asked Questions

How can a rural EMS unit acquire an ambulance or fire truck?

The following programs can assist in obtaining an ambulance or fire truck for a rural EMS unit:

There are also several commercial websites specializing in EMS equipment. Examples include:

Many municipal and volunteer fire and emergency services departments obtain surplus government property through the Federal Surplus Personal Property Donation Program. To inquire further about this program, contact your State Agency for Surplus Property (SASP).

How does a rural EMS unit obtain an AED?

There are several funding opportunities listed in the RAC EMS Funding section of this topic guide. The Rural Access to Emergency Devices (RAED) Grant Program, from the Office of Rural Health Policy, provides funding to rural communities to purchase automated external defibrillators (AEDs) and to train in their use and maintenance.

Contact your state's EMS office for any available funding. The National Association of State EMS Officials has a listing of these offices.

Check with your state office of rural health. They may be aware of state or regional funding for AEDs.

Are there continuing education programs for EMS personnel?

Several of the organizations and tools listed in this topic guide contain continuing education information. In addition, FEMA provides a comprehensive list of training and education resources available from the U.S. Fire Administration (USFA), including course offerings from both the Emergency Management Institute (EMI) and the National Fire Academy (NFA). The NHTSA Office of EMS has developed and revised educational materials and resources for EMS personnel, programs, and systems.  

Where is there a listing of state EMS contacts?

A listing of state EMS contacts is available from the National Association of State EMS Officials.

Can and should a rural hospital be part of the regional and statewide trauma system?

Yes. Given that death rates for injury are higher in rural and frontier areas it is imperative that all rural acute care facilities that receive emergency patients be part of the trauma system. This allows for a more organized response at the local level and ensures that those patients who need interventions and care above your facility’s capabilities are identified and transferred to a higher level of care in a timely manner. Evidence clearly supports the notion that an inclusive system that involves all facilities results in fewer unnecessary trauma deaths.

Where is there information about regional or statewide trauma systems?

The best place to start is with the state trauma program manager. In most cases that person works in the state EMS office, but also could work in the office of rural health or in a freestanding program. The National Association of State EMS Officials provides a general phone and website address for state EMS officials. HRSA has prepared a Farm Rescue and EMS: A State by State Directory.

Are there training programs to assist a rural medical and ancillary staff become better organized and prepared to receive injured patients?

There are two programs specific to this task:

How can local EMS agencies be integrated into the local and regional systems of trauma care?

The local acute care facilities often play an important role in engaging local EMS agencies in issues surrounding trauma care. Often the EMS agency’s medical director is affiliated with the local facility. This provides a natural bridge between the two agencies on issues of triage protocols, trauma team activation and quality improvement activities. It is, sometimes, helpful to engage in a specific community planning process that sets out to use existing EMS resources more effectively through horizontal integration at the community level. A planning process and associated materials are found in Community-Based Needs Assessment: Assisting Communities in Building a Stronger EMS System.

What are the different levels of trauma care and are these levels mandated by the federal or state governments?

There are no national standards or federal designations for levels of trauma care. According to the American College of Surgeons (ACS) the designations of trauma care facilities is a geopolitical process by which empowered entities such as state governments are authorized to designate. Often it will be the state EMS office that will determine what those standards are. Some states use the ACS verification process, which is voluntary, to determine the levels of trauma care for their healthcare facilities.

Although ACS does not designate trauma centers it will verify the presence of resources that are listed in their document, Resources for Optimal Care of the Injured Patient. This document can be ordered from the ACS website. For additional information on the levels of trauma care see the ACS document: Definitive Care Facilities. ACS also provides on their website a list of trauma centers that have successfully completed a verification visit.

Are there statistics and data on trauma related deaths and nonfatal injuries treated in emergency departments?

Centers for Disease Control (CDC) has the most authoritative information on injury deaths and disability through the WISQUARS database. This is an interactive, online database that provides customized injury-related mortality data and nonfatal injury data useful for research and for making informed public health decisions.