With hospital closures and need for reliable funding, rural America's emergency medical services seek new solutions

Rural ambulance in Sweetwater, Wyoming
(Photo by Kim Raff, The New York Times)

You can call 911, but in some rural places, no one can come immediately, no matter your emergency. "Nearly 4.5 million people across the U.S. live in an 'ambulance desert' – 25 minutes or more from an ambulance station – and more than half of those are residents of rural counties," reports Nada Hassanein of USA Today, citing a study by the Maine Rural Health Research Center and the Rural Health Research Centers. "As rural hospitals shutter across the nation, dwindling emergency medical services also must travel far to the nearest hospital or trauma center. Experts and those in the field say Emergency Medical Services need a more systematic funding model to support rural and poorer urban communities."

Lead study author Yvonne Jonk, deputy director of the center, told Hassanein, "This is a really extreme problem, and we need to figure out solutions. People think that when you call 911, that someone's coming in. Most people don't realize that their communities don't actually have adequate coverage." Hassanein reports, "Four of 5 counties across the nation have at least one ambulance desert, according to Jonk's analysis of 41 states and data from 2021 and 2022."

The inability of many rural areas to have and staff an emergency response team has several reasons. From the truck to the equipment to professional dispatchers and emergency medical technicians, an ambulance service is an expense most areas are expected to cover but can't. Hassanein writes, "The McDermitt Paiute-Shoshone Tribe reservation stretches along the Nevada-Oregon border near Idaho and has no ambulance or hospital. . . . Tribal chairwoman Maxine Redstar said the community used to have an ambulance service, but it couldn't afford to keep it going. . . . Weather, wildlife and long, dark winding gravel roads make getting to the scene difficult." Redstar told Hassanein: "When you call an ambulance, it comes from Winnemucca, which is an hour away."

For many rural areas, funding an ambulance service can be a major obstacle. "Few states designate EMS as an essential service. In the U.S., EMS are mainly funded by local governments, and not all states allocate supplemental funds toward the services,"Hassanein reports. "Amid patchwork funding, communities rely on varied revenue sources to fund ambulance services, said Lindsey Narloch, project manager at Rural EMS Counts, a North Dakota EMS improvement project. That often doesn't cover expensive equipment, medication and staff salaries. Counties end up having to pay most of the cost."

Having and staffing an EMS services may require a new model. Hassanein explains, "Gary Wingrove, president of The Paramedic Foundation, noted that critical access hospitals, which are medical centers in rural, underserved communities often with a high number of uninsured residents, are paid more than other hospitals if their care delivery cost is higher than the standard Medicare payment."  Wingrove told Hussanein: "We have to take a hard look at our financing of rural ambulance services. And to me, it just makes a lot of sense if we create a system like the critical access hospitals have for the rural ambulance services."