by Tom Nehring, Co-chair of the Joint Committee on Rural EMS Care (JCREC) and Division Director at the North Dakota Department of Health, Division of EMS and Trauma
The current transformation of healthcare delivery in the rural areas provides for some additional challenges regarding EMS access. While this transformation may provide additional obstacles to effective rural EMS, it may also provide for some additional opportunities for EMS to provide better healthcare and better value in the rural and frontier areas of the country.
A natural movement toward regionalization of healthcare in rural areas is occurring. The appropriate treatment of time-critical conditions may necessitate additional transportation to regional centers that maintain trauma designation, stroke designation, and potentially cardiac designation, where true definitive care can be rendered. This additional transportation may have a major impact on EMS access.
One of the major issues affecting EMS access in the rural areas is the availability of workforce. Because of traditionally low volumes of ambulance runs, many ambulance services in rural areas survive because of the volunteer nature of the service, not on revenue generated through the provision of services. We call this the “volunteer subsidy,” which normally makes up the largest percentage of a volunteer ambulance service budget but does not reflect in real dollars the sacrifice it takes to keep the services functioning on a day-by-day basis.
With regionalization of healthcare, we are asking more of the volunteers: more run time, greater distance to move patients to regional centers, and time when they could be available within their communities. In an ever decreasing pool of volunteers, we are asking for more than initial care of the ill or injured and transportation to the local hospital.
While on the surface the main problem appears to be availability of personnel, we must recognize that we need to envision the provision of EMS in a new light. This may be where some opportunities exist for the future. While we need to change how we provide emergency care, especially in time-critical conditions, we also need to investigate what additional value EMS providers can offer rural communities. One of the more common current approaches is the provision of community health through community paramedics. In traditional healthcare-starved communities, this approach can offer a degree of community healthcare where very little exists.
We need to expand this role to include other levels of EMS providers, not just paramedics. Community Healthcare Worker training, along with traditional levels of EMS certification, may provide this community support while also providing for additional revenue to help justify the existence of services within rural communities.