Rural Emergency Medical Services (EMS) and Trauma – Resources
Selected recent or important resources focusing on Rural Emergency Medical Services (EMS) and Trauma.
Rural EMS Regionalization - Opportunities and Policy Considerations
Explores models of emergency medical services (EMS) at the state level. Includes a case study exploring successes in Minnesota and offers policy recommendations to overcome common rural EMS challenges.
Author(s): Eli Steenhoek, Lauren Lavin, Keith Mueller
Date: 08/2025
Sponsoring organization: Rural Policy Research Institute Rural Health Panel
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Explores models of emergency medical services (EMS) at the state level. Includes a case study exploring successes in Minnesota and offers policy recommendations to overcome common rural EMS challenges.
Author(s): Eli Steenhoek, Lauren Lavin, Keith Mueller
Date: 08/2025
Sponsoring organization: Rural Policy Research Institute Rural Health Panel
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Quantitative Effects of Mechanical Cardiopulmonary Resuscitation Devices in Rural American Emergency Medical Services: A Retrospective Cohort Study
Examines the effect of mechanical cardiopulmonary resuscitation on out-of-hospital cardiac arrest incidents in rural areas and the usefulness of new technologies on rural emergency medical services (EMS). Utilizes 2017–2019 National Emergency Medical Services Information System data to analyze 585 rural cardiac arrests and the impact of mechanical cardiopulmonary resuscitation on EMS care quality.
Author(s): Peter H. King, Esmaeil Bahalkeh
Citation: International Journal of Emergency Medicine, 18, 151
Date: 08/2025
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Examines the effect of mechanical cardiopulmonary resuscitation on out-of-hospital cardiac arrest incidents in rural areas and the usefulness of new technologies on rural emergency medical services (EMS). Utilizes 2017–2019 National Emergency Medical Services Information System data to analyze 585 rural cardiac arrests and the impact of mechanical cardiopulmonary resuscitation on EMS care quality.
Author(s): Peter H. King, Esmaeil Bahalkeh
Citation: International Journal of Emergency Medicine, 18, 151
Date: 08/2025
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Characteristics and Trends of Critical Access Hospitals That Own or Operate Ambulance Services
Explores trends in the number of Critical Access Hospital (CAH)-based ambulance services between 2017 and 2022. Analyzes Medicare Cost Report data to compare the characteristics of of CAHs that own and operate ambulance services to CAHs that do not. Presents findings from interviews with eight CAH-based ambulance services regarding the challenges of operating these services, including workforce recruitment and retention issues, the role of partnerships and community involvement, and lessons learned.
Author(s): John Gale, Karen Pearson, Rebecca Stearns, Zachariah Croll
Date: 05/2025
Sponsoring organization: Flex Monitoring Team
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Explores trends in the number of Critical Access Hospital (CAH)-based ambulance services between 2017 and 2022. Analyzes Medicare Cost Report data to compare the characteristics of of CAHs that own and operate ambulance services to CAHs that do not. Presents findings from interviews with eight CAH-based ambulance services regarding the challenges of operating these services, including workforce recruitment and retention issues, the role of partnerships and community involvement, and lessons learned.
Author(s): John Gale, Karen Pearson, Rebecca Stearns, Zachariah Croll
Date: 05/2025
Sponsoring organization: Flex Monitoring Team
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AHRQ Summit to Address Emergency Department Boarding: Technical Report
Report from an October 2024 Agency for Healthcare Research and Quality (AHRQ) summit to discuss emergency department boarding. Examines some of emergency physicians' biggest concerns and highlights possible solutions to address boarding head-on, including enhancing measurement and standards, re-aligning hospital incentives, and increasing support to empower emergency physicians to do their jobs effectively. Includes sections on rural patients and rural areas.
Author(s): Robin M. Weinick, Sean Bruna, Rachael M. Boicourt, Sean S. Michael, Laura L. Sessums
Date: 01/2025
Sponsoring organization: Agency for Healthcare Research and Quality
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Report from an October 2024 Agency for Healthcare Research and Quality (AHRQ) summit to discuss emergency department boarding. Examines some of emergency physicians' biggest concerns and highlights possible solutions to address boarding head-on, including enhancing measurement and standards, re-aligning hospital incentives, and increasing support to empower emergency physicians to do their jobs effectively. Includes sections on rural patients and rural areas.
Author(s): Robin M. Weinick, Sean Bruna, Rachael M. Boicourt, Sean S. Michael, Laura L. Sessums
Date: 01/2025
Sponsoring organization: Agency for Healthcare Research and Quality
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Examining Differences in Rural and Urban Medicare FFS Beneficiaries' Emergency Department Use Before and During COVID-19
Results of a study describing changes from 2018-2022 in emergency department use among rural and urban Medicare Fee-for-Service (FFS) beneficiaries. Features statistics including patient demographics, primary diagnoses, and admission sources, with breakdowns by urban and rural areas.
Author(s): Alana Knudson, Craig D. Holden, Marilyn Klug, Tricia Stauffer, Shena Popat
Date: 01/2025
Sponsoring organization: ETSU/NORC Rural Health Research Center
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Results of a study describing changes from 2018-2022 in emergency department use among rural and urban Medicare Fee-for-Service (FFS) beneficiaries. Features statistics including patient demographics, primary diagnoses, and admission sources, with breakdowns by urban and rural areas.
Author(s): Alana Knudson, Craig D. Holden, Marilyn Klug, Tricia Stauffer, Shena Popat
Date: 01/2025
Sponsoring organization: ETSU/NORC Rural Health Research Center
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Emergency Triage, Treat, and Transport (ET3) Model: Final Evaluation Report
Presents quantitative and qualitative results from the evaluation of the Emergency Triage, Treat, and Transport (ET3) Model, a voluntary model that allowed ambulance care teams to use alternate models of emergency healthcare to improve quality and lower care costs. Describes the characteristics of ET3 participants, the extent to which ET3 interventions successfully prevented emergency department (ED) visits, and how average Medicare Parts A and B spending for patients that received ET3 interventions compared to patients who had low acuity ED visits. Discusses challenges and barriers to delivering ET3 interventions. Includes rural references throughout.
Additional links: Findings at a Glance, Technical Appendix
Date: 01/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Presents quantitative and qualitative results from the evaluation of the Emergency Triage, Treat, and Transport (ET3) Model, a voluntary model that allowed ambulance care teams to use alternate models of emergency healthcare to improve quality and lower care costs. Describes the characteristics of ET3 participants, the extent to which ET3 interventions successfully prevented emergency department (ED) visits, and how average Medicare Parts A and B spending for patients that received ET3 interventions compared to patients who had low acuity ED visits. Discusses challenges and barriers to delivering ET3 interventions. Includes rural references throughout.
Additional links: Findings at a Glance, Technical Appendix
Date: 01/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Medicare Ground Ambulance Data Collection System (GADCS) Report: Year 1 and Year 2 Cohort Analysis
Provides data from the first two cohorts of ground ambulance organizations selected to participate in the Ground Ambulance Data Collection System. Includes response rates, information on data cleaning and validation, statistics summarizing responses, and analyses exploring relationships between costs per service and organizational characteristics. Features statistics with breakdowns by urban, rural, and super rural areas.
Additional links: Codebook
Author(s): Andrew W. Mulcahy, Sara E. Heins, Petra W. Rasmussen, et al.
Date: 12/2024
Sponsoring organizations: Centers for Medicare and Medicaid Services, RAND Corporation
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Provides data from the first two cohorts of ground ambulance organizations selected to participate in the Ground Ambulance Data Collection System. Includes response rates, information on data cleaning and validation, statistics summarizing responses, and analyses exploring relationships between costs per service and organizational characteristics. Features statistics with breakdowns by urban, rural, and super rural areas.
Additional links: Codebook
Author(s): Andrew W. Mulcahy, Sara E. Heins, Petra W. Rasmussen, et al.
Date: 12/2024
Sponsoring organizations: Centers for Medicare and Medicaid Services, RAND Corporation
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Emergency Medical Services (EMS): A Look at Disparities in Funding and Outcomes
Details disparities related to rurality, income, sex, and race in emergency medical services (EMS) funding, staffing, and patient outcomes. Provides a case study of local EMS agencies in 11 California counties, highlighting challenges rural agencies face related to funding and quality of care.
Date: 10/2024
Sponsoring organization: Centers for Disease Control and Prevention
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Details disparities related to rurality, income, sex, and race in emergency medical services (EMS) funding, staffing, and patient outcomes. Provides a case study of local EMS agencies in 11 California counties, highlighting challenges rural agencies face related to funding and quality of care.
Date: 10/2024
Sponsoring organization: Centers for Disease Control and Prevention
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Medicare Payment Basics: Ambulance Services Payment System
Provides an overview of Medicare payments for ambulance services. Discusses rural add-on payment policies, geographic categories determining payment rates, super-rural ZIP codes, and ambulance fee schedules.
Date: 10/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Provides an overview of Medicare payments for ambulance services. Discusses rural add-on payment policies, geographic categories determining payment rates, super-rural ZIP codes, and ambulance fee schedules.
Date: 10/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Workforce Toolkit to Support Critical Access Hospitals and Rural Providers
Toolkit intended to help Critical Access Hospitals (CAHs) and other rural providers improve workforce recruitment and retention efforts. Provides information on healthcare workforce challenges faced by CAHs. Offers examples of external resources that CAHs may utilize to address their workforce needs across four topics: organizational culture and leadership, leveraging partnerships, emergency medical services workforce, and administrative and support staff workforce.
Date: 09/2024
Sponsoring organization: Flex Monitoring Team
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Toolkit intended to help Critical Access Hospitals (CAHs) and other rural providers improve workforce recruitment and retention efforts. Provides information on healthcare workforce challenges faced by CAHs. Offers examples of external resources that CAHs may utilize to address their workforce needs across four topics: organizational culture and leadership, leveraging partnerships, emergency medical services workforce, and administrative and support staff workforce.
Date: 09/2024
Sponsoring organization: Flex Monitoring Team
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Additional resources are available related to this guide. See the full list of resources by topic for:
- Emergency department and urgent care services
- Emergency medical services
- Emergency medical technicians and paramedics
Last Updated: 9/11/2025