In N.C., the $50 billion federal Rural Health Transformation Program won't eliminate health care deserts

North Carolina plans to use its RHTP money on hospitals
and clinics that are open. (KFF photo)

The $50 billion Rural Health Transformation Program Congress created in 2025 to ensure the passage of President Donald Trump's One Big Beautiful Bill Act may sound like it's made to help closed rural hospitals or hospitals on the brink of shuttering, but in reality, the act strictly limits the amount of RHTP grant money struggling hospitals can use to stay afloat.

The RHTP funding restrictions haven't stopped midterm-stumping politicians in North Carolina from touting the program as a salve for rural hospitals in financial straits, report Sarah Jane Tribble and Amanda Seitz of KFF Health News. "Republican candidates in competitive midterm elections are casting the fund as a lifeline that will shore up critical rural health services across America."

In Martin County, N.C., where lawmakers face competitive midterm elections, some residents believe RHTP funds will help reopen their shuttered hospital, Tribble and Seitz report. "Martin County won’t get direct relief from Trump’s rural health fund — because its hospital isn’t open." The state plans to use its $213 million in RHTP funds on "existing health and social service organizations."

Without rural hospitals, residents in states like North Carolina, where most citizens live in rural counties, are especially vulnerable. During a medical emergency, when every second counts, rural residents must survive the travel distance to get medical care. Some don't make it. Tribble and Seitz explain, "Martin County does not have paramedics on its ambulances, and it can be 20 miles or more to the closest — and often overcrowded — emergency rooms."

Brian Floyd, the chief operating officer for ECU Health, which operates out of Greenville, N.C., told KFF, "It’s a real healthcare crisis that has already proven itself to have lost lives that perhaps didn’t have to be lost. They just want to not die because there’s nowhere to go when you have an emergency."

Virtual Crisis Care connects rural law enforcement with mental health resources during emergencies

Virtual Crisis Care programs, expanding from South Dakota into Wyoming, are helping law enforcement in rural communities gain on-demand access to mental health professionals to de-escalate emergency situations, reports Madeline de Figueiredo for The Daily Yonder.

Officers connect with the telemedicine network Avel eCare in real-time, effectively helping about 80% of individuals across the country to receive care safely at home rather than being unnecessarily hospitalized or incarcerated, Figueiredo explains.

A clinician from Avel eCare specifically assigned to an individual “conducts a risk evaluation, creates a safety plan, and works with officers on next steps,” Figueiredo reports. Because Virtual Crisis Care isn’t just for an emergency response, these next steps always include connecting the individuals with local community health centers for follow-up care.

This program, funded by the Helmsley Charitable Trust, has been used in South Dakota for over five years by more than 30 rural law enforcement departments. Last year, the program was introduced to the Wyoming Association of Sheriffs and Chiefs of Police (WASCOP), with about 25% of law enforcement agencies participating so far.

“I think if you look at serving in rural America, not only on the criminal side but on the mental health side, you deal with the same people over years and decades. If you can get someone struggling with addiction or mental health into treatment and help them change their life, then we’re not seeing them anymore on the law enforcement side of things,” the executive director of WASCOP, Allen Thompson, told Figueiredo.

Quick hits: The American baked potato; rural deputies get EMS training; 6 states ban lab-grown meat sales; building homes in small town Vermont

American-grown potatoes are still affordable and 
delicious. (Idaho Potato Commission photo)

In a time when going to the grocery store can be both expensive and discouraging, it's good for Americans to reignite their love for the humble, versatile and still affordable baked potato. "The baked potato has always been big and great," writes Eric Kim of The New York Times. "These days, a long Idaho tuber, split down the middle like a hot dog bun to reveal fluffy white starch, a pat of butter nestled into the left side, is still big and — more important — great, with its perfect creamy-crunchy-fresh combo of sour cream, chives, cheese and bacon." Find recipes here. 

A rural sheriff in Montana is working to help the region's emergency responders by using "some of his department’s budget to restart a first responder medical training and certification program for deputies to be able to supplement emergency medical providers and help provide care when they are first to the scene of an incident," reports Blair Miller of the Helena Independent Record. Often, when accidents occur in rural Montana, law enforcement arrives well before medical emergency teams. In his announcement, Sheriff Tom Grim said he believes that if deputies could provide medical assistance to victims before an ambulance arrives, their additional training could save lives. 

Six states have passed laws banning cultivated meat.
(Graphic by Adam Dixon, Offrange)

Where's the meat? According to several states, only animals are meat. "Livestock powerhouse Nebraska became the sixth state to preemptively ban the sale of cultivated meat," reports Jaclyn De Candio for Offrange. Nebraska joined the "beef with cultivated meat" by joining states that already ban the sale of lab-grown meat, including Florida, Alabama, Mississippi, Montana and Indiana. "Florida was the first to pass such a law, and in several cases, companies like UPSIDE Foods already filed lawsuits challenging these restrictions on constitutional and commerce grounds. . . . While laboratory meat products are indeed made from real cattle cells, they give pause to many."

Power grids across the country need upgrades, and areas of the Midwest will get them. "The Department of Energy closed a $1.6 billion loan guarantee for transmission upgrades in the middle of the country — a move that comes as the Trump administration slashes funding for other grid improvements, including a separate transmission megaproject in the Midwest," reports Alexander C. Kaufman of Canary Media. The financing will enable a subsidiary of American Electric Power to "overhaul around 5,000 miles of power lines across Indiana, Michigan, Ohio, Oklahoma, and West Virginia."

A bucket of Kentucky Fried Chicken may be a game-day crowd-pleaser, but the chain has been struggling against competitors that offer on-the-go chicken. "Consumers eat 26% of their fast-food orders in their cars," reports Heather Haddon of The Wall Street Journal. To recapture its market share, the company is revamping its menu to compete with newcomers like Chick-fil-A and Canes. "KFC this month brought back its Original Honey BBQ sandwich, introduced in the late 1990s, at a discounted $3.99 price. The announcement swiped at Chick-fil-A while championing its own sandwich: 'bigger than Chick-fil-A’s AND available on Sundays.'"

Jonah Richard’s first development project was once home to a post office. It now consists of eight apartments and a coffee shop. (Photo by David Littlefield, Vermont Public Media)

Despite the daunting challenges of building affordable housing in New England, a homegrown Vermonter found a way to get it done. "Not so long ago, Jonah Richard spent his days working for a white-collar consulting firm in New York City. Now, he fills his time bopping between construction sites in the corner of Vermont where he grew up," reports Carly Berlin of vtdigger. "His philosophy of trying to squeeze more housing into any possible nook and cranny in a building, and in a town – guides all of the projects that Richard takes on through his small construction company and development business. . . . State officials want to clone Jonah Richard."

Rural communities build 'resilience hubs' designed to prepare for emergencies through interdependence

Resilience Hub Collaborative map

Working to address immediate needs following a natural disaster or emergency event, several rural communities are building "resilience hubs as a model for a quick and reliable first line of defense and relief," reports Kim Kobersmith of The Daily Yonder.

"People are awakening to the fact that neighbors are the real first responders, and thinking ahead is vital," Kobersmith writes. "The hubs provide some level of preparation and support for residents in a disruption and beyond."

Every community hub is a little bit different, and "can range from a mobile solar energy source to a central building able to feed community members in a crisis to a community center offering year-round services," Kobersmith adds.

A spirit of community interdependence is at the heart of each hub, where community members commit to preparing for, rather than reacting to, emergencies. The action-focused nonprofit Resilience Hub Collaborative can help communities plan and build their hub.

Ki Baja, an experienced hub organizer with the collaborative, told Kobersmith, "Studies have shown for decades that connectivity, social cohesion, is the number one indicator for successful recovery from disruptions."

Rural women in Colorado with 'high-risk' pregnancies often travel long distances or take helicopters for care

Women in rural Colorado who encounter pregnancy complications often face long drives for care, with some having to take helicopters to reach treatment at a larger medical center. "Every year, more than 60 air medical transfers are made for pregnant patients in Colorado’s Eastern Plains, where helicopters regularly fly in to transport them to hospitals," reports Priya Shahi of Rocky Mountain PBS.

Graph by Priya Shahi, from Prowers Medical Center data

As more rural hospitals reduce or end obstetric care, emergency transportation, such as helicopters, has become more common. Emergency air flight can be for the health of the mom, the unborn baby or for after-delivery specialty care.

In Lamar, Colo., pregnant patients can receive routine prenatal care at Prowers Medical Center; however, its obstetric care is limited and expecting moms with more "high-risk" conditions are often transferred or flown to facilities with higher levels of care. 

While some women don't need more expert care or equipment until closer to delivery, some have to travel long distances throughout pregnancy. One patient in Lamar "has to make bimonthly trips to Colorado Springs just for ultrasounds," Shahi writes. 

She told Shahi, "My husband has to take time off just to take me, so we lose income just to go that far. We’re already struggling in the economy that it is. To take me up there for a two-minute appointment, it’s rough." A one-way drive from Lamar to Colorado Springs takes roughly 3 hours.

Emergency departments in some rural areas don't have 24/7 on-site physician coverage

A hospital in Ekalaka, Mont., sits at the intersection of two dirt roads. 
(Photo by Arielle Zionts, KFF Health News) 

Many rural emergency rooms are no longer run by attending physicians, but instead depend on care by nurse practitioners and physician assistants. "A recent study found that in 2022, at least 7.4% of emergency departments across the U.S. did not have an attending physician on-site 24/7," reports Arielle Zionts for KFF Health News. "More than 90% were in low-volume or critical access hospitals — a federal designation for small, rural hospitals."

The 2022 report represents "82% of hospitals that responded to a survey sent to all emergency departments in the country, except those operated by the federal government," Zionts writes. "The study is the first of its kind, so there isn’t proof that such staffing arrangements are increasing, said Carlos Camargo, the lead author and a professor of emergency medicine at Harvard Medical School."

The idea of an emergency department without a doctor on staff remains controversial, and not all states allow it. "Some doctors and their professional associations say physicians’ extensive training leads to better care, and that some hospitals are just trying to save money by not employing them," Zionts explains. Indiana, Virginia, and South Carolina have passed laws that require all their EDs to have a 24/7 physician on-site.

Even when states require their EDs to staff a round-the-clock doctor, that doesn't make finding one easy. "In the Dakotas, more than half of emergency departments were running without 24/7 attending physician staffing," Zionts reports. In response to the regional shortage, Sioux Falls-based Sanford Health launched an emergency medicine residency to help increase its ED physician numbers.

Some rural health advocates say lawmakers need to be sure that employing full-time ED physicians 24/7 is feasible for their region before passing legislation that requires it. Zionts adds, "Camargo said some doctors say that if lawmakers are going to require 24/7 on-site physician coverage in ERs, they need to pay to help hospitals implement it."

American emergency alert systems continue to face challenges in reaching everyone in harm's way

Tornado sirens are designed to warn people outside to take cover. 
 (Photo by G. Johnson, Unsplash)

Despite significant improvements in American emergency alert technology, the country often fails to broadcast warnings that reach people in time. "Federal, state and local authorities share responsibility for alerting citizens that they are in danger," report Drew FitzGerald, Josie Reich and Caitlin Ostroff of The Wall Street Journal. "But the country’s patchwork of digital and physical emergency-alert tools is often a step behind Mother Nature, with deadly consequences."

The tragic July 4th flooding, where, in Kerr County alone, there were more than 90 confirmed fatalities, offers a sobering picture of how much can go wrong. "There were repeated flash flooding warnings in Kerr County, as rain moved in and the Guadalupe River surged at the start of the July 4 weekend," the Journal reports. "Those alerts never reached some of the campers and residents who lacked cellphone service, silenced notifications or didn’t have phones with them, and outdoor sirens were considered but never built."

Texas is not alone. Human errors during the January Los Angeles wildfires caused some text alerts to be delayed, with some even sent to the wrong areas. During Maui's deadly wildfires, cellphone networks failed, leaving some residents who would have received text warnings unaware and unable to seek safety in time.

Besides Mother Nature's stealth, human error and the unpredictability of first-time disasters, what else is going wrong? "The Federal Emergency Management Agency’s internet-based alert system has made it easier for local authorities to reach residents," they write. "But industry experts say some rural officials often lack the funding, expertise or permission from state authorities to push their own alerts through broadcasters and cellphones."

Too many alerts "can cause cellphone users to shut off notifications that become bothersome or irrelevant. A menu of warnings for floods, fires, missing children and more have caused 'alert fatigue' in some areas," the Journal reports. "The FCC is working on changes that would let authorities send muted or vibrate-only notifications in less-dire situations. Those changes won’t go into effect until 2028."

Rural areas struggling to provide local Emergency Medical Services use creative solutions to fill the void

Southern Henry Ambulance Service’s new hub is a barn in
Knightstown. (Photo by Grayson Joslin, Indiana Capital Chronicle)

The safety net local Emergency Medical Services provides to rural communities has been faltering, leaving some areas without an EMS team to respond to urgent calls. The shortage has some areas creating their own EMS solutions.

Residents of Knightstown, Indiana, have lived without an ambulance service since January 2023, when the regional ambulance service closed due to financial losses and a lack of volunteers. "The town, situated in the southern portion of Henry County, is 25 minutes away from the county seat, New Castle, which has their own EMS services and hospital," reports Grayson Joslin of the Indiana Capital Chronicle. "But sometimes the New Castle EMS may have other calls to answer, so it could be anywhere from 45 minutes to an hour for EMS to get to Knightstown."

Knightstown resident and EMT volunteer Kevin Richey decided to explore how Knightstown might develop its own EMS service. Joslin writes, "Richey asked around the Knightstown community to see if there would be support to create a new nonprofit from scratch for providing EMS resources. . . . Southern Henry Ambulance Service was approved as a 501(c)3 nonprofit in early 2023, and started a fundraising effort across Knightstown and on GoFundMe to get the service off of the ground."

Just east of Henry County lies Fayetteville County, Indiana, where over half of the population lives in a rural area. The county has its own ambulance service, but still struggles to meet its call volume. "The county lost its only hospital in 2019," Joslin explains. "This has put an additional strain on its existing EMS operations. Runs that used to take two to three minutes to make now take about 30 to 35 minutes."

Increasing local taxes proved to be a solution to some of Fayetteville's staffing problems. "In 2024, both the Connersville City Council and the Fayette County Council approved a 0.25% public safety tax on income to go toward providing more funds to the county’s various public safety services," Joslin reports. "Fayette County EMS chief Clint Hardin said the funding from the tax allowed him to give his employees a $5,000 raise."

While tax increases are often unpopular, they can finance local needs that most residents support. Hardin told Joslin, "What people kinda lose sight of is property taxes is the only tax that we pay that is 99% local. That funds police, fire, EMS, your streets, your parks, your libraries, your schools. You get to see the benefit of your tax dollars.”

Fire departments can't get trucks or truck repair parts because the industry has consolidated to make big profits

Fire departments can wait years for a new fire truck.
(Adobe Stock photo)

Firefighters and fire trucks are the backbone of fire protection in most communities, but over time, keeping fire trucks repaired or buying replacements has become increasingly difficult. "Fire engine manufacturing is now largely controlled by three companies," report Mike Baker, Maureen Farrell and Serge F. Kovaleski of The Wall Street Journal. "Some departments have waited years for replacement vehicles while hunting the internet for parts to keep their older rigs going."

Wall Street executives sought to eliminate competition among fire truck makers "in a plan to boost profits from fire engine sales," the Journal reports. "One company, backed by a private equity firm, cut its own manufacturing lines as part of a streamlining strategy and then saw a backlog of fire engine orders soar into billions of dollars."

Edward Kelly, general president of the International Association of Fire Fighters, said the pandemic caused production delays, but it isn't the main problem. He told the Journal: "In hindsight, it was masking what ends up being a main driver of higher cost and lag time in production: the monopolizing of fire truck and ambulance manufacturing in the United States. . . . Absent competition, monopoly capitalism is a shakedown.”

With no new competitors in sight, U.S. fire departments have no choice but to order from the three big companies that still make trucks. One of those companies, Rev Group "has created a more standardized vehicle that can be made in less than a year," the Journal reports. "If more fire departments choose this standardized model, said Mike Virnig, a Rev Group executive, it is likely that overall wait times will drop."

Editor in North Carolina had to balance his storm-reporting duties with his other roles as a firefighter and EMT

Moss Brennan

Moss Brennan is editor of the Watauga Democrat newspaper in western North Carolina, and he also is a volunteer firefighter and an emergency medical technician. As Lauren Watson reports for Columbia Journalism Review, Brennan had to balance those roles as the flooding and winds from Helene led to extensive damage and hundreds of emergency rescues where he lives and works. 

In addition to his job at the Watauga newspaper, Brennan also is executive editor of Mountain Times Publications, which serves three rural counties in the region. 

As Watson reported, "In the days leading up to the arrival of Hurricane Helene last week, he was preparing for what he imagined would be some flooding and structural damage — possibly a handful of dramatic rescue missions — to report on. But he never anticipated the breadth of devastation and destruction that Helene would ultimately bring."

When the storm hit, Brennan first focused on his emergency services duties. “'If there is somebody that is hurt or their life is on the line, that comes first, before the story,'' he told Watson. "Balancing the two roles can be tricky ('I’m human, so it’s not perfect'), but Brennan also recognizes the responsibility that comes with his newspaper job."

Brennan told Watson: "I oversee the papers in Ashe, Watauga, and Avery counties, and during the week, we were the only outlet able to offer regular updates and reports to those communities."

As he delivered papers to people throughout the devastated communities, he found them welcoming of trustworthy information the newspapers provided. "I met people who told me that this was the first news they had gotten since last week.

"The Watauga County emergency services also asked for a bunch of papers so that their own damage assessment teams could give them out to people who lost everything and had no information about what was going on."

Quick hits: Trucks for farmers; guide for emergency alerts; Native Americans enter elections; PORKtober is here!

AGwagon kits make trucks tough enough for farming.
(Photo by Matthew J. Grassi, Farm Journal)

Farmers who want a truck built for the rigors of farming can now make one with "AGwagon," aftermarket kits, reports Matthew J. Grassi of Farm Journal. "There has never been a pickup truck 100% purposely built for farmers and ranchers. . . . The kits convert off-the-factory-line trucks into rugged and tough, back 40 devouring, farm equipment hauling beasts. . . . The AGwagon kits were built off feedback from a panel of 14 farmers and ranchers."

Signing up for emergency alerts may sound simple, but often it's not. This group made an emergency alert guide that can be a model for other communities, reports Natasha Uzcátegui-Liggett of CalMatters. "If you’re interested in publishing a comprehensive emergency alert guide for your state, you can start with our article on CalMatters (it’s free to republish if you credit us clearly, and the majority of it applies to all states), and then swap out the section titled 'How to sign up for your county’s alerts' with your reporting for your state. . . "

Humans and other animals have more than one 'prong' of defense against germs.
(Knowable graphic)

Immune systems are part of living creatures' defenses against bacteria and viruses, but they aren't the only type of protection. "Some scientists think we should devote more attention to a second prong of defense: one that allows our bodies to more harmlessly live with pathogens until they’re cleared from our systems," reports Liam Drew of Knowable. "There is a substantial body of research showing various ways in which animals can tolerate, and so survive, maladies such as malaria, sepsis and dysentery."

Dr. Stephen Loyd

He was a physician, then an opioid addict, and now he's West Virginia's "drug czar," reports Leah Willingham of The Associated Press. "Dr. Stephen Loyd, who has been treating patients with substance use disorder since he got sober two decades ago, says combating opioid addiction in the state with the highest rate of overdose deaths isn’t just his job. It’s an integral part of his healing. . . . Loyd says he is ready to help advise the state's foundation on how to distribute the nearly $1 billion in settlement money saying the state has a 'moral and ethical responsibility' to spend it wisely."

Amid election year tensions and negativity, there are some bright spots. This November, "a record-breaking number of Native Americans are running for state and local office," reports Daniel C. Volk of Route Fifty. "Advance Native Political Leadership, a group that works to increase Native American representation at those levels of government, says there are 230 Native candidates running across the country this year, up from 100 when it first started counting in 2016. About 80% of this year’s candidates are women."

Deanne Frieders

It's PORKtober, and "This Farm Girl Cooks" web writer Deanne Frieders can help you decide "what's for dinner," even if you're delivering supper to a field of workers, reports Jennifer Shike of Farm Journal. "As a cook, she loves how versatile pork is to cook with as it can take on so many flavor profiles from Italian to Tex-Mex to Asian." To explore Frieders' website full of farmer-friendly meals, click here.

PFAS, also known as "forever chemicals," can cause devastating health issues for humans, partially because they build up in the body over time. Much of the concern over PFAS has been their "everlasting" presence in U.S. water supplies, but this town has succeeded in removing them, reports Pien Huang of NPR. "Yorba Linda is a small, sunny city southeast of Los Angeles. It’s home to the nation’s largest per- and polyfluoroalkyl (PFAS) water treatment plant of its kind." The plant can serve as a model for other communities.

Outdated 911 systems mean dispatchers sometimes misdirect help. Two technologies could provide solutions.

Outdated technology limits dispatchers' effectiveness.
(FirstNet photo)

In an emergency, most people call 911 and expect a dispatcher to answer the call and send help to the correct place. But U.S. emergency centers are facing their own crisis and not every dispatch is getting sent to the right place, reports Chris Teale of Route Fifty. "With outdated technology that is prone to outages, as well as low staffing and maps that may not be up to date with the newest streets," emergency responders are sometimes misdirected. Many 911 services still rely on 1980s technology, with many rural communities lagging behind their urban counterparts.

The situation sounds dire, but "experts say there’s a possible solution to these problems," Teale explains. "The interplay of two technologies —FirstNet and Next Generation 911 — could help bolster 911 dispatching and bring it up to date. . . . But it will take time, money and political support to make it a reality -- even though there is broad agreement on the issues dispatchers face."

FirstNet "gives public safety agencies their own interoperable broadband network in partnership with AT&T," Teale explains. "It covers more than 2.97 million square miles across every state and territory, and was created after the Sept. 11, 2001, terrorist attacks highlighted shortcomings in emergency response communications networks." FirstNet technology could benefit rural America where its high-power towers and satellites can reach more remote places faster and more accurately.

From better location services to the ability to receive scene photos or texts from callers, Next Generation 911-technology helps dispatchers and emergency responders locate and manage a crisis more effectively. FirstNet's dedicated connections work in tandem with Next Generation's features. But the systems can be cost-prohibitive for communities. Teale adds, "Some have urged the federal government to step in and bear some of that cost."

An EMS system in Letcher County, Kentucky, could serve as a warning for other struggling rural emergency services

When rural fire departments struggle to make ends meet, taking out a loan to cover costs may make sense. But as emergency services in Letcher County, Kentucky, discovered, that can lead to serious problems.

"Letcher Emergency Medical Service is deep in debt and hemorrhaging money, with some employees saying they have missed paydays and a Chicago area lender with a history of lawsuits against it threatening to repossess everything the service owns," reports Sam Adams of The Mountain Eagle in Whitesburg, Kentucky. "Employees say most if not all of those who missed checks have now been paid, but some have left the ambulance service for other pursuits, worried there won't be any money to pay them."

A natural disaster followed by missteps that hurt Medicaid reimbursements is partly blamed for Letcher EMS's financial woes. "After the 2022 flood, Letcher EMS changed its mailing address from the destroyed firehouse and ambulance station to a board member's home," Adams explains. "When Medicaid figured out it was a residential address, it stopped sending checks. That problem ballooned into another one. No checks from Medicaid, no checks to employees and no money to pay debts."

Shawn Gilley, executive director of the service, agreed that the "service has had financial difficulties, but said he has partnered with an unnamed financial backer to pay off debts and try to keep the service open," Adams reports. "Beginning earlier this year, a man identifying himself as Paul Graver of First Government Lease in Northfield, Illinois, began calling The Mountain Eagle asking for information about Letcher Volunteer Fire Department and Kingscreek Volunteer Fire Department and trying to get the newspaper to write a story saying Letcher owed him money."

Grave "listed 11 ambulances and fire trucks as being subject to repossession in a phone call with the newspaper."

While Letcher EMS leadership admitted to borrowing from First Government Lease, it's difficult to say how much is owed or what equipment could be repossessed. "Gilley acknowledges that he borrowed the money. . .. Both [Gilley and Fire Chief Wallace Bolling] have said that First Government has no claim on the fire trucks," Adams reports. 

Letcher EMS is one of several EMS organizations that are financially entangled with First Government Lease. "Court records show fire departments from Warfield, Ky., Pigeon Roost, Ky., Pinecrest, Tenn., Clinton, La., Alexander, Ark., Scott County, Ark., and Illinois" are involved with the company, Adams writes. 

Plagued by EMS worker shortages and poor funding, rural EMS services in Minnesota get some much-needed help

Lawmakers approved a new pilot program to address the
state's rural EMS response times. (Adobe Stock photo)

Rural ambulance services have been short-staffed for years, but in Minnesota, the situation has become so extreme that lawmakers have stepped in with financial support and a 'sprint' pilot program. "The 'EMS emergency' declared by Minnesota lawmakers is far from over, but rural services in the state recently got some good news," reports Elizabeth Daigneau of Route Fifty. Legislators approved a $30 million aid package for rural emergency medical services.

The bill provides $24 million in emergency aid for EMS providers and focuses on providing relief to the state's non-urban regions. "It would also create a new Office of Emergency Medical Services to oversee Minnesota's EMS network," Daigneau explains. "Most notably, it would provide $6 million to launch a 'sprint medic' pilot program in three counties in northern Minnesota."

The sprint medic concept is meant to streamline EMS responses by "sending out a single paramedic in a car or truck directly to an emergency to begin treatment," Daigneau reports. "The idea is that these roving paramedics who would be patrolling the area have more training than the current emergency medical technicians. . . . They could reach emergencies more quickly. . . and, in some cases, resolve calls to keep ambulances with advanced life support equipment from being dispatched unnecessarily."

While $30 million won't solve all the EMS struggles, it will help response times. David Kirchner, evaluation coordinator for the Minnesota Office of the Legislative Auditor, told Daigneau, "In some communities, the situation is becoming dire enough that not only are the ambulances not sufficient, but there's not even someone to answer the phone when 911 calls the ambulance company."

The bill was routed to Gov. Tim Walz’s desk for approval. While it isn't the $120 million originally requested, Daigneau adds, "supporters say it still provides some much needed relief."

Early week quick hits: Addressing mental health issues; finding funny stories; using lasers to make birds leave

Colorado Department of Agriculture photo via Successful Farming

Farming and ranching are two livelihoods that are tough on the human body and mind. For men and women in either or both professions, seeking help for mental stress can mean overcoming social stigmas and a lack of access. A new film, Legacy, from the Colorado Department of Agriculture and Colorado Farm Bureau aims to break down social barriers for farmers and ranchers who experience isolation and mental health issues, reports Lisa Foust Prater of Successful Farming. The film takes viewers into the stories of "several farmers and ranchers who share glimpses into their lives, including losing a loved one to suicide or facing their own struggles with mental health. . . .They speak candidly about the struggles faced by those working in agriculture and the difficulties with finding help." Watch the film here.

Cancer used to be a disease people mostly over 50 had to worry about. Now, many younger people are turning up with aggressive cancers, and researchers can't yet explain what has changed. "Adults in the prime of their lives, often otherwise outwardly healthy, are dying of cancers that appear to develop more quickly and be more deadly than in the past, for reasons that scientists cannot adequately explain, reports Dylan Scott of Vox. "Scientific authorities around the world see this as one of the most pressing questions for modern medicine."

Reading a funny book can make life sweeter.
(Adobe Stock photo)

One of The Rural Blog writers insists that the world needs more laughter. With that idea in mind, here are 22 books that could help you giggle, guffaw, chortle and even snort out loud. "The humor these authors embrace traverses the gamut, from sardonic to screwball, mordant to madcap, droll to deranged," report Dwight Garner, Alexandra Jacobs and Jennifer Szalai of The New York Times. "The critic Albert Murray understood that wit is power, and that knowing where the funny is takes us closer to the nub of things. Best of all, it's available to anyone. As Murray wrote, 'It is always open season on the truth.'"

As many rural hospitals and clinics have closed or limited services, getting medical care or chronic health treatment services has become an uphill battle for residents. The American Heart Association visited Alaska, Kansas, Kentucky, the Dakotas and West Virginia to shed light on rural health challenges and how residents and communities are working to overcome obstacles. Their exploration and discussions are presented in the docuseries, "Health Wanted: Find Care in Rural America." Click here for each state's episode.

Lasers can deter birds.
(Bird Control Group photo via SF)

Some Wisconsin farmers use lasers to keep wild birds away from their animals, reducing their chance of avian flu exposure. "When the human eye examines one of Craig Duhr's lasers at a Wisconsin farm, only a green dot is visible. But to birds, a variety of green beams and shifting patterns appear," reports Jonah Beleckis of Wisconsin Public Radio. Laser beams do not harm birds, but the birds "simply see the lasers as a threat and leave the area. . . . Wisconsin's agriculture department recommends farmers use biosecurity measures, such as lasers, to protect poultry flocks."

Maine Monitor analysis,
from State Fire Marshal data

Maine firefighters have the cool trucks and trademark hats, and some even have a station dog. But fighting fires is not what they spend most of their time doing. Amber Stone of The Maine Monitor reports, "A mere 4.5 percent of the 160,435 calls for service in 2022 were for fires, according to a Monitor analysis of State Fire Marshal data. Seventy percent of those calls were for emergency medical response. More than half of Maine's 338 registered fire departments are also licensed at some level to provide emergency medical services, according to Maine EMS, and more are considering doing so."

Landline use might be fading, but many rural residents still rely on it during power outages and emergencies

Landlines don't go down during power
outages. (Photo by A. Spratt, Unsplash)

When emergencies strike in remote areas, the unreliability of cell phone and broadband services can become a stark reality, which is why many rural residents want to keep their landlines. "The number of landline users has plummeted, and providers are looking at transitioning customers to cellphones or home telephone service over broadband connections," reports Heather Kelly for The Washington Post. "But for millions of people, newer alternatives are either unavailable, too expensive, or are unreliable when it matters most: in an emergency."

Because landline phones use copper lines to transfer electricity, "as long as a phone is corded or charged, it will work during a power outage," Kelly explains. "Landlines are unaffected by power outages, making them a necessary backstop in rural areas. Many of those same areas have inadequate cellular or internet coverage."

Enumclaw in King County, Wash., sits in
the shadowof Mt. Rainier. (Wikipedia map)

About a quarter of Americans still have a landline, but far fewer rely on it for daily use. "The largest group of people holding onto their landlines are 65 and older," Kelly reports. "Susan Reiter has had a landline in her Enumclaw, Wash., home since 1978. The power goes out multiple times a year, says Reiter, usually caused by fierce wind and other weather events. But the landline always works, she says, making it her best option if there's an emergency and she needs to call 911."

AT&T is one company looking to cut costs by cutting landline service. It asked the California Public Utilities Commission to "end its obligation to provide landline service in parts of the state," Kelly adds. "Hundreds of California residents called into CPUC public meetings. . . .The vast majority said maintaining landline service was a safety issue, citing power outages, wildfires and floods as times when their landlines are the only way to reach 911 or get information on evacuations."

As calling options evolve, replacing landlines as an emergency stopgap seems possible; however, getting people to trust newer technology may be tricky. "Apple added a satellite-connected emergency response service to the iPhone 14 in 2022," Kelly reports. "For people with a landline they've had for decades, the promise of new technology doesn't compete with the security of something that has worked for so long."

Some rural hospitals face a difficult choice of closing in-patient beds to focus instead on 24/7 emergency care

Hospitals with the special designation won't offer
inpatient care. (Photo by G. Rosenke, Unsplash)

Rural hospitals that are struggling financially have an option to receive more federal funding if they focus on emergency services instead of inpatient care. But less than 20 hospitals have made that switch since it became available in January 2023, reports Devna Rose for The Associated Press. 

She writes: "Rural emergency hospitals receive more than $3 million in federal funding a year and higher Medicare reimbursements in exchange for closing all inpatient beds and providing 24/7 emergency care."

There are downsides to the changes, both for rural residents and the hospitals. Rose writes, "People might have to travel further for treatments for illnesses that require inpatient stays, like pneumonia or Covid-19. In some of the communities where hospitals have converted to the new designation, residents are confused about what kind of care they can receive."

According to the AP report: “'It’s ironic' that the facilities that might need the most help can’t afford to take the risk, said Carrie Cochran-McClain, chief policy officer at the National Rural Health Association. She pointed to having to give up certain services and benefits, such as a federal discount program for prescription drugs."

Only 19 hospitals have made the change so far, according to the University of North Carolina's Sheps Center for Health Services Research. But "Brock Slabach, the National Rural Health Association’s chief operations officer, told the AP that upwards of 30 facilities are interested in converting to rural emergency hospitals this year."

A small town in Texas struggles to manage immigration numbers -- its first responders are often overwhelmed

Migrants walk along concertina wire on the U.S. side of the
border in Texas. (Photo by Paul Ratje, The New York Times)

Emergency workers and town officials in Eagle Pass, Texas, have been overwhelmed by the thousands of immigrants who require rescuing from Rio Grande River perils, heat exhaustion or the physical demands of wrangling with border obstacles, as they attempt to cross into the U.S., reports Edgar Sandoval of The New York Times. "This week, a delegation of 60 Republican congressmen, including House Speaker Mike Johnson, gathered in town at the edge of the Rio Grande to call for the Biden administration to stem the immigration surge."

Eagle Pass is home to a border patrol station, but the town is not equipped to handle the number of people crossing. "Many [immigrants] are in urgent need of medical attention when they arrive — help that is only available through a city that is already straining to meet the needs of its own 28,000 residents," Sandoval writes. "The city has had to assign one of its five ambulances full-time to transport injured migrants from the river's edge."

Eagle Pass, Texas (Wikipedia maps)

Meanwhile, the cost of aiding, treating and managing migrants is straining the town's fire department and law enforcement. The Fire Department is "spending about $150,000 a month on ambulance costs responding to migrants alone. . . .That figure does not include overtime, costing more than $30,000 a month, Sandoval reports. "The Eagle Pass police chief, Federico Garza, says his small police force of 74 officers is often diverted from everyday duties to respond to calls of migrants idling on a corner or crossing through a backyard. The sheer number of calls 'can be overwhelming,' he said."

Texas has "long been at the center of U.S. immigration policy," Sandoval adds. "But the area has turned into a key point of friction this year between Republican leaders and the Biden administration, as Gov. Greg Abbott of Texas openly defied federal authority and set up state law enforcement patrols, concertina wire and floating buoys along the border in a bid to keep new migrants out of the state."

In January, the flow of immigrants into Eagle Pass slowed, but some of the efforts hurt the town's economy. "The recent closure of an international crossing known locally as Bridge 1 crippled a local economy that benefits from a steady stream of Mexicans who legally cross every day to eat at restaurants, fill their gas tanks and commute to work," Sandoval reports. "The closure over the holiday season cost the city about $1 million, Rolando Salinas Jr., the mayor of Eagle Pass, said."

Opinion: Veterans Administration plan to change some ambulance transport coverage needs to be halted for study

Over a quarter of veterans are rural residents.
(The Daily Yonder photo)

If the Veterans Administration succeeds in changing its transportation coverage, rural towns and counties may not be able to handle the additional ambulance travel costs, write William Enyart and Doug Jameson in their opinion for The Daily Yonder. "The Veterans Administration wants to pass the cost for ambulance transport on to other agencies and local governments." With over 25% of all military veterans residing in rural areas, funding those trips will "hit rural areas hard."

Rural-living veterans often require ambulance travel. "With more than 15 million veterans eligible for VA care, there are many thousands of ground and air ambulance trips each year, and they come at a large financial cost. The VA has quietly decided that the cost is too great for it to bear," Enyart and Jameson explain. "Beginning in early 2024, reimbursements will be significantly reduced for veterans who receive ambulance rides to VA-approved hospitals. Those who receive ambulance rides to non-VA-approved hospitals will see reimbursements cut to near zero."

Why is the VA doing this now? According to many who watch the VA closely, the plan is to "create a funding gap – a crisis – that will compel other government entities to step forward and fill that void," Enyart and Jameson write. "Some combination of state, county and municipal government would see the crisis unfold and then rush forward with a funding solution because to do this to veterans is unthinkable."

The unexpected funding gap will hurt local governments that haven't had time to plan for increasing costs and "can't just find the money," Enyart and Jameson point out. "It is possible more well-off areas would be able to respond, but that doesn't account for other, more numerous. . . rural areas where so many of our fellow veterans live. . . .That leads to an even greater concern of how affected veterans might respond. Knowing costs are out of reach, will they simply forego medical treatment? Or, might they attempt another, less safe way to travel to a medical facility?" Enyart and Jameson add that private ambulance services that rely on VA funding may opt out of servicing unprofitable areas, many of which would be rural.

There is a way to prevent this disaster, Enyart and Jameson write, "First, congressional leaders should publicly call for a study to be done that examines the effect that changes to ambulance reimbursement would have on our veterans' health. Second, congressional working groups should be established and informed by veterans' affairs experts from the local, state and federal levels to determine the possibility of non-VA funding of ambulances for veterans. And, finally, the VA must pause the date that its reimbursement cuts will go into effect until the results of these efforts are fully known and examined publicly."

Rural trauma deaths would decline if ambulances could bill insurance companies for delivering blood on way to hospital

A fire-district ambulance on a dirt road after a training exercise near Fruita, Colo., last April. The West and parts of the South pose big challenges for rural emergency medical services. (Photo by Smiley Pool, Dallas Morning News)

In 2020, a traumatic injury killed an American every 31½ minutes, and such injuries are the top killer of children and adults under 45. Those statistics could be better if more ambulances carried blood and could bill insurance companies for administrering it, Lauren Caruba of the Dallas Morning News reports in a package with the San Antonio Express-News focused on rural America.

The problem is worst in the sparsely populated West, but "parts of the South performed worse compared with the coasts," Caruba reports. The package focuses on western Colorado and has an interactive map showing how far every location in the 48 contiguous states is from a trauma center.

"The vast majority of emergency medical providers . . . are unequipped and underfunded, leaving them unprepared to fully treat patients with severe internal bleeding," Caruba writes. "Across the country, bleeding patients receive drastically different care depending on where they are injured and the emergency providers who treat them." Awareness of the issue "has been mostly confined to medical journals and discussions within the medical community, leaving the general public largely uninformed about the extent of the epidemic."

"The solution is straightforward: If paramedics widely carried blood, as military medics have done for years, tens of thousands of lives could be spared annually. But the country’s fragmented health-care system does not allow for an easy fix. . . . Despite repeated pleas from specialists, the federal government has not prioritized or properly invested in the plight of injured Americans."

With each minute that passes after a potentially fatal injury, the possibility of death increases, "especially within the first half-hour, when severe bleeding deaths peak," Caruba notes, citing research. "An estimated quarter of all Americans live further than a 30-minute drive from Level I or II trauma centers, which provide the highest level of care to injured patients."

The Defense Department has greatly improved combat death rates with faster evacuation, "increased tourniquet use and administered blood on the way to the hospital," Caruba notes. "No such overhaul has happened in U.S. health care, and efforts have not been made to broadly adopt the military’s best practices, particularly before patients reach a hospital."

In 2019, fewer that 1% of trauma patients "received blood products of any kind on the way to the hospital, even when they displayed clear warning signs of bleeding out," Caruba reports, citing research by the University of Alabama-Birmingham. She notes that there is relatively little research into trauma deaths, and that the federal government doesn't even track them. But a federal report in 2016 estimated that 20,000 to 30,000 trauma deaths a year were potentially avoidable.

The U.S. has more than 23,000 emergency medical services, but only about 100 ground services have blood, "trauma advocates have found in recent surveys. While most air ambulance companies carry blood products, they treat only a small fraction of injured patients," Caruba reports. "Blood is a costly, limited resource, and most emergency medical providers lack relationships with blood banks. They also face regulatory and logistical hurdles, like maintaining blood refrigeration temperatures in the field and creating a system where unused units do not go to waste."

The Prehospital Blood Transfusion Initiative Coalition is focusing on the servcies' "inability to bill insurers for the cost of the blood and the rules in some states that prevent paramedics from starting transfusions," Caruba reports. "The group hopes to present recommendations to Congress and the National Association of State EMS Officials next year. Their goal is that every patient with major bleeding — including the injured and those hemorrhaging from medical complications — will receive blood if they need it."