Rural EMS
Rural communities are unique, and require unique solutions. Challenges that rural EMS agencies face include longer response and transport times, communities with high burdens of disease and disability, financial stressors, staffing challenges, and difficulty accessing training and medical expertise.
How Can UW Medical Directors Help?
We can help build your leadership team.
Board-certified EMS physicians are unique amongst physicians, because they are required to understand a wide range of regulatory, administrative, political, financial, and human resources issues applicable to EMS. They are clinicians, but can also serve as trusted advisors and mentors. By collaborating with UW EMS physicians, your agency’s leaders will have more resources to learn and grow.
We have solutions to your unique training needs.
Our EMS physicians are able to provide training at flexible times, including evenings, to maximize attendance from both volunteers and paid employees.
Whenever possible, we prioritize traveling to your station to deliver in-person training. We operate the only dedicated training ambulance in the region, which allows us to bring high-fidelity simulation to your station.
When distance or weather are prohibitive to in-person training, our team can provide high-quality, live, virtual training through Zoom or other web conferencing tools.
We have experience working with rural agencies.
UW provides EMS medical direction for multiple agencies operating in rural communities, including Belleville Area EMS, Brooklyn Fire & EMS, Berlin EMS, District One EMS, and Southern Green Lake County Ambulance. In our capacity as medical directors, we have assisted leadership in assessing and navigating multiple issues, including:
- Service level upgrades
- Novel recruitment strategies, including cadet programs and internships
- Decisions on capital purchasing
- Risk-benefit discussions related to integration, regionalization, and mutual aid
- Strengthening pediatric readiness
- Implementing scenario-based training programs
Challenges Facing Rural EMS
Long distances and challenging terrain prolong emergency response and transport times.
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The median response time in rural areas is more than double that of urban areas (PDF).
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Rural hospital closures eliminate the local safety net and force rural EMS clinicians to transport patients farther (PDF).
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Rural residents are 1/5th as likely to live within 60 minutes of a Level I/II trauma center (PDF).
Rural communities experience disproportionately high burdens of disease.
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20% of the US population lives in rural areas, but 41% of fatal traffic accidents occur in rural areas (PDF).
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Rural residents are more likely than non-rural residents to die after traumatic injuries (PDF).
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The age-adjusted death rate is higher in rural communities, most notably due to heart disease, cancer, and chronic lung disease (PDF).
Demographics and health care utilization in rural communities are different.
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In Wisconsin, rural residents are more likely to be above the age of 65. Those below the age of 65 are more likely to be disabled (PDF).
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Rural residents have lower outpatient health care utilization despite having higher burdens of disease (PDF).
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Rural residents disproportionately use the emergency department for their care (PDF).
Financial stressors affecting EMS are amplified for rural agencies.
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EMS must be staffed and ready to respond at any time (the cost of readiness). In low volume agencies, this cost is distributed over fewer calls, raising the breakeven point for each response (PDF).
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In 2023, average base-rate Medicaid reimbursement only covered 9.9% of the average cost of service (PDF).
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In 2023 in Minnesota, at least 62% of billable EMS responses failed to recoup their true expenses, with financial losses ranging up to $463.44 per response (PDF).
The rural EMS workforce contains a large number of volunteers.
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In Wisconsin, 51% of EMS agencies have crew rosters with 75% or more volunteers. These volunteers are predominantly BLS providers, whose care generates fewer Medicare RVUs than ALS (PDF).
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The age of volunteerism is waning. From 1984 to 2020, there was a decline of 220,850 volunteer firefighters nationally, despite a population growth of 95 million people (PDF).
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Seven full-time staff working 24-hour shifts are needed to staff one ambulance. In 2022 in Wisconsin, 41% of agencies had six or fewer staff providing 80% of staffing hours (PDF).
Rural EMS agencies lack access to training opportunities and medical expertise.
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In Wisconsin, 73% of rural EMS providers need to drive 30+ minutes to the nearest training center. Agencies that rely on volunteers struggle to train during business hours (PDF).
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Rural agencies rely on volunteer medical directors twice as often as urban agencies. These medical directors are less likely to be trained in emergency medicine and tend to have lower levels of participation (PDF).
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Agencies serving rural areas are less likely than other agencies to perform procedures according to the 2019 National EMS Scope of Practice Model (PDF).
