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Rural Emergency Medical Services (EMS) and Trauma Resources

Selected recent or important resources focusing on Rural Emergency Medical Services (EMS) and Trauma.

Medicare Payment Basics: Ambulance Services Payment System
Provides an overview of Medicare payments for ambulance services. Discusses rural counties including rural and super-rural zip codes, metropolitan statistical areas, rural add-on payments, ambulance fee schedules, and payment rates.
Date: 10/2018
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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EMS Services in Rural America: Challenges and Opportunities
Policy brief describing challenges for rural EMS providers, including workforce shortages and inconsistent funding. Features statistics including percentage of potentially excess deaths for 5 leading causes of death, with breakdowns by metropolitan and nonmetropolitan areas, and average EMS call time response and distribution of all-volunteer and all-paid staff EMS agencies, with breakdowns by 4 levels of population density. Discusses effects of the opioid crisis and Critical Access Hospital closures on provision of EMS services.
Author(s): Nikki King, Marcus Pigman, Sarah Huling, Brian Hanson
Date: 05/2018
Type: Document
Sponsoring organization: National Rural Health Association
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Recruitment and Retention: Overcoming the Rural EMS Dilemma
Reports on rural emergency medical services (EMS) workforce challenges and identifies innovative approaches to meet these challenges, highlighting programs in several states. Includes a list of 4 EMS recruitment and retention tactics for rural communities.
Author(s): Jenn Lukens
Citation: Rural Monitor
Date: 02/2018
Type: Document
Sponsoring organization: Rural Health Information Hub
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Traffic Safety Facts 2016
Presents rural and urban fatal crash data and reports average emergency medical service (EMS) response times at the state-level. Includes rural fatal crash data by roadway function, crash type, speed limit, and more.
Date: 2018
Type: Document
Sponsoring organization: National Highway Traffic Safety Administration
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Ambulance Services for Medicare Beneficiaries: State Differences in Usage, 2012-2014
Policy brief analyzing how ambulance use varies among U.S. communities. Features state-level statistics including number of Medicare patients transported by ambulance, miles transported, and number of days ambulance transport was used per patient. Compares mean characteristics of states by census division, including percentage of population living in rural areas.
Author(s): SuZanne Troske, Alison Davis
Date: 10/2017
Type: Document
Sponsoring organization: Rural & Underserved Health Research Center
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Trends in Emergency Department Visits, 2006–2014
Presents information on emergency department (ED) visits and trends in the U.S. between 2006 and 2014 based on data from the Healthcare Cost and Utilization Project (HCUP). Covers ED visit frequency by age, sex, metro/nonmetro location, primary payer type, region, diagnosis, and several other indicators.
Author(s): Brian J. Moore, Carol Stocks, Pamela L. Owens
Date: 09/2017
Type: Document
Sponsoring organization: Agency for Healthcare Research and Quality
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Air Ambulance: Data Collection and Transparency Needed to Enhance DOT Oversight
Addresses various aspects of air transport for critically ill patients, including the amount charged for service, factors affecting the service, and actions the federal government could take to provide pricing oversight. Discusses the implications and importance of air transport for rural areas throughout.
Additional links: Full Report
Date: 07/2017
Type: Document
Sponsoring organization: Government Accountability Office
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Lights and Siren Use by Emergency Medical Services (EMS): Above All Do No Harm
Examines the use of lights and sirens by EMS vehicles and minutes saved compared to crash risk for rural, urban, suburban, and wilderness settings in the U.S.
Author(s): Douglas F. Kupas
Date: 05/2017
Type: Document
Sponsoring organizations: Maryn Consulting, Inc., National Highway Traffic Safety Administration
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Disparities in Access to Trauma Care in the United States: A Population-Based Analysis
Describes the geographic, demographic, and socioeconomic disparities in access to trauma care in the U.S., including a rural and urban analysis of disparities. Covers data detailing demographic characteristics stratified by trauma center access by income, poverty, insurance status, education, race/ethnicity, rurality, and more.
Author(s): Brendan Carr, Ariel Bowman, Catherine Wolff, et al.
Citation: Injury, 48(2), 332-338
Date: 02/2017
Type: Document
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Early Death After Discharge From Emergency Departments: Analysis of National US Insurance Claims Data
Report regarding the incidence of early death after release from emergency departments in the United States and what risk factors may contribute to those deaths. Compares urban and rural hospital location, with data for Critical Access Hospitals (CAHs) and rural non-CAHs. Includes data for rural and urban populations as well as poverty level, previous healthcare use, and other demographics.
Author(s): Ziad Obermeyer, Brent Cohn, Michael Wilson, Anupam B Jena, David M Cutler
Citation: BMJ, 356(j239)
Date: 02/2017
Type: Document
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Rural Risk: Geographic Disparities in Trauma Mortality
Examines injury mortality between rural and urban residents with traumatic injuries using data from the 2009 to 2010 Nationwide Emergency Department Sample study. Includes rural and urban statistics by age group, mortality, trauma designation, census region, and other variables.
Author(s): Molly P. Jarman, Renan C. Castillo, Anthony R. Carlini, Lisa M. Kodadek, Adil H. Haider
Citation: Surgery, 160(6), 1551-1559
Date: 12/2016
Type: Document
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NACRHHS Policy Briefs on Emergency Care Models and Rural Opioid Misuse Implications
September 2016 webinar discussion of two policy briefs sent to the Secretary of the U.S. Department of Health and Human Services (HHS) regarding alternative provision for emergency care due to rural hospital closures and the impact of opioid misuse in rural communities. Presented by members of the National Advisory Committee on Rural Health and Human Services including Former Governor Ronnie Musgrove, Committee Chair; Kelly Evans, Chief Executive Officer for Beartooth Billings Clinic, Red Lodge, MT; and Paul Moore, Executive Secretary.
Additional links: Audio Recording, PowerPoint Handout, Transcript
Date: 09/2016
Type: Video/Multimedia
Sponsoring organization: Rural Health Information Hub
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EMS Leaders Speak
Five experts discuss emergency medical services in a changing rural healthcare delivery system. Topics addressed include EMS challenges and potential opportunities, such as community paramedicine and telehealth.
Author(s): Kevin McGinnis, Diane Calmus, Don Wood, Tom Nehring, Gary Wingrove
Citation: Rural Monitor
Date: 09/2016
Type: Document
Sponsoring organization: Rural Health Information Hub
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Alternative Models to Preserving Access to Emergency Care
Explores proposals to maintain timely access to emergency and other basic healthcare services in rural communities that may not be able to support a full-service hospital. Identifies models of care and various ideologies for the Secretary and the Department of Health and Human Services to consider when evaluating policy options for an alternative model of care in rural communities.
Date: 07/2016
Type: Document
Sponsoring organization: National Advisory Committee on Rural Health and Human Services
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National Characteristics of Emergency Medical Services in Frontier and Remote Areas
Outlines national characteristics for emergency medical services in Frontier and Remote Areas (FAR). Includes patient demographics, provider clinical impression and injuries, and procedures performed in FAR and non-FAR patients.
Author(s): Landon R. Mueller, John P. Donnelly, Karen E. Jacobson, et al.
Citation: Prehospital Emergency Care, 20(2), 191-199
Date: 2016
Type: Document
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Estimated Costs of Rural Freestanding Emergency Departments
Provides an overview of the rural freestanding emergency department (RFED) model as a feasible alternative for hospitals at risk of closure, or preparing for closure, to keep emergency services within the rural community.
Author(s): J. Dunc Williams, Paula H. Song, George H. Pink
Date: 11/2015
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Secondary Overtriage in a Statewide Rural Trauma System
Analysis of secondary overtriage in West Virginia hospitals to determine the efficiency of a statewide rural trauma system. Table 1 details non-transfer and transfer patient characteristics and table 5 details factors linked with secondary overtriage.
Author(s): Jorge Con, Dustin Long, Emily Sasala, et al.
Citation: Journal of Surgical Research, 198(2), 462-467
Date: 10/2015
Type: Document
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Comparison of Rates of Emergency Department Procedures and Critical Diagnoses in Metropolitan and Rural Hospitals
Compares experiences of emergency physicians practicing in rural and urban emergency departments to determine differences in the rates of selected procedures and critical diagnoses.
Author(s): James Waymack, Stephen Markwell, Joseph Milbrandt, Ted Clark
Citation: Rural and Remote Health, 15, 3298
Date: 10/2015
Type: Document
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Report to Congress: Evaluations of Hospitals’ Ambulance Data on Medicare Cost Reports and Feasibility of Obtaining Cost Data from All Ambulance Providers and Suppliers
Exploration of the use of cost surveys and reports to collect data on ambulance services, examination of development of a standard cost reporting tool for providers of services and suppliers of ground ambulance services, and examination of the ability to furnish cost data by various types of ambulance providers of services and suppliers, especially for rural and super-rural providers. Features statistics from fiscal years 2007-2012 relating to costs, number of trips by type of hospital, distribution of provider/supplier trip volume, origin-destination pairs, and barriers experienced by people in geographically isolated areas.
Date: 09/2015
Type: Document
Sponsoring organization: U.S. Department of Health and Human Services
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Rural Ambulatory Access for Semi-Urgent Care and the Relationship of Distance to an Emergency Department
Examines how distance to emergency departments (ED) and urgent care (UC) facilities impact semi-urgent ambulatory appointments, and assesses the effect of insurance and ability to pay cash on a patient’s achievement in scheduling appointments in rural and suburban areas of the Eastern U.S.
Author(s): Ashley Parks, Andy Hoegh, Damon Kuehl
Citation: Western Journal of Emergency Medicine, 16(4), 594-599
Date: 07/2015
Type: Document
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Emergency Department Visits and Proximity to Patients’ Residences, 2009-2010
Provides data on how often patients go to the emergency department (ED) closest to their home. Includes comparisons for patients living inside metropolitan statistical areas (MSAs) and outside MSAs, with data on whether patients visited the closest ED by patient age, hospital visit volume, and ED wait times.
Author(s): Amy M. Brown, Sandra L. Decker, Frederic W. Selck
Date: 03/2015
Type: Document
Sponsoring organization: National Center for Health Statistics
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Emergency Medical Services Leadership Education: A State-by-State Compendium of EMS Leadership Development Education
Results of a survey of 48 National Association of State EMS Officials (NASEMSO) member states and territories. Features statistics including breakdowns by type of EMS education program, target audience, instructional methodology, incentives for participation, funding sources, and certification benefits.
Date: 11/2014
Type: Document
Sponsoring organization: National Association of State EMS Officials
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How EMS in Rural Methow Valley, Washington, Coped with a Devastating Wildfire
Describes EMS response in the aftermath of a wildfire, in which patients and providers were cut off from hospitals, 911 coverage, and power. Shows the importance of advanced preparedness and planning by rural EMS agencies.
Author(s): Cindy Button
Citation: JEMS (Journal of Emergency Medical Services), 39(10), 46-9
Date: 10/2014
Type: Document
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Overview of Emergency Department Visits in the United States, 2011
Provides data on emergency department (ED) visits, including information on ED visits in rural areas.
Author(s): Audrey J. Weiss, Lauren M. Wier, Carol Stocks, Janice Blanchard
Date: 06/2014
Type: Document
Sponsoring organization: Agency for Healthcare Research and Quality
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Pediatric Emergency Care Capabilities of Indian Health Service Emergency Medical Service Agencies Serving American Indians/Alaska Natives in Rural and Frontier Areas
Analyzes the Indian Health Service's (IHS) emergency medical services (EMS) agencies concerning services for children. Discusses the importance of EMS services for healthcare access and challenges IHS EMS agencies face.
Author(s): Andrea L. Genovesi, Betty Hastings, Elizabeth A. Edgerton, Lenora Olson
Citation: Rural and Remote Health, 14, 2688
Date: 05/2014
Type: Document
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Rural Emergency Medical Technician Pre-Hospital Electrocardiogram Transmission
Rural communities face challenges to rapid emergency response services for heart attacks, mostly related to prolonged travel time. As a strategy to address this, this research article sought evidence of the risks and benefits associated with electrocardiogram (ECG) protocols, which urban ambulance teams staffed with paramedic level providers have been successful in implementing.
Author(s): Angela Powell, Joshua Halon, Jessica Nelson
Citation: Rural and Remote Health, 14, 2690
Date: 05/2014
Type: Document
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Resources for Optimal Care of the Injured Patient 2014
Discusses regional trauma systems and levels of trauma centers. Chapter 13 focuses on rural trauma care.
Author(s): Michael F. Rotondo, Chris Cribari, R. Stephen Smith
Date: 2014
Type: Document
Sponsoring organization: American College of Surgeons
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Strategy for a National EMS Culture of Safety
Written for EMS leaders and organizations who support development of a culture of safety for EMS personnel and the community. Discusses the role of volunteerism in rural communities, as well as education for all EMS personnel.
Date: 10/2013
Type: Document
Sponsoring organization: National Highway Traffic Safety Administration
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National Hospital Ambulatory Medical Care Survey: Rural Emergency Departments
Highlights the number of visits to emergency departments of rural hospitals from 2007-2010. Includes reasons for visit, diagnoses, age, medications used, and sources of payment.
Date: 05/2013
Type: Document
Sponsoring organization: Centers for Disease Control and Prevention
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Emergency Department Transfers to Acute Care Facilities, 2009
Presents national estimates on emergency department visits in 2009. Discusses emergency department transfers to other acute care hospitals, with information by location of patient residence for urban and rural locations.
Author(s): Dana Kindermann, Ryan Mutter, Jesse Pines
Date: 05/2013
Type: Document
Sponsoring organization: Agency for Healthcare Research and Quality
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Emergency Medical Services Response to Motor Vehicle Crashes in Rural Areas: A Synthesis of Highway Practice
Identifies potential factors that may help reduce the time needed to provide effective medical care to crash occupants on rural roads. Includes rural statistics and data.
Date: 04/2013
Type: Document
Sponsoring organization: National Cooperative Highway Research Program
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Research Prioritization Topic Brief: Rural Trauma Care
Provides an overview of issues that impact rural trauma outcomes. Discusses priority research areas with the potential to improve care and patient-centered outcomes.
Date: 04/2013
Type: Document
Sponsoring organization: Patient-Centered Outcomes Research Institute
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Services Integration Strengthens Rural EMS
By integrating rural EMS with other services, programs in Oregon, Minnesota, and Maine are improving patient care, EMS response times, and provider skills. Features Minnesota’s Comprehensive Advanced Life Support (CALS) educational program, Maine's Emergency Medical Services, and several programs in Oregon.
Author(s): Candi Helseth
Citation: Rural Monitor
Date: 08/2012
Type: Document
Sponsoring organization: Rural Health Information Hub
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Local and National Efforts Improve Rural EMS Safety
Discusses how local safety practices are increasing EMS safety, but more and wider coordination is needed. Features Rowan County EMS in North Carolina, and Gold Cross/Mayo Clinic Medical Transport of Minnesota and Western Wisconsin.
Author(s): Candi Helseth
Citation: Rural Monitor
Date: 08/2012
Type: Document
Sponsoring organization: Rural Health Information Hub
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Funding Alternatives for Emergency Medical and Fire Services
Identifies various grants and funding available for emergency medical services (EMS) and fire protection services. Mentions rural throughout.
Date: 04/2012
Type: Document
Sponsoring organization: U.S. Fire Administration
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Rural Highway Mass Casualty Guidelines: Resources for State and Local Officials
Discusses rural highway mass casualty readiness. Focuses on improving response in rural areas of state EMS systems, and to further collaboration with state offices of highway safety and state traffic safety engineering staff.
Date: 03/2012
Type: Document
Sponsoring organization: National Association of State EMS Officials
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2011 National EMS Assessment
Provides a comprehensive description of emergency medical services, EMS emergency preparedness, and 911 systems at state and national levels. Chapters 9, 10, 158, and 194 discuss rural EMS, including rural status, rural patient transports, and Critical Access Hospitals.
Author(s): Greg Mears, Beth Armstrong, Antonio R. Fernandez, et al.
Date: 12/2011
Type: Document
Sponsoring organization: National Highway Traffic Safety Administration
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Mobile EMS Lab Improves Critical Care in Nevada's High Desert
Highlights Humboldt General Hospital Emergency Medical Services (HGH-EMS), in Nevada, which is taking ultrasound and lab out in the field to improve patient outcomes in rural areas.
Author(s): Candi Helseth
Citation: Rural Monitor, 2011(Fall)
Date: 11/2011
Type: Document
Sponsoring organization: Rural Health Information Hub
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The Emergency Medical Services Workforce Agenda for the Future
Identifies components critical to developing an EMS workforce for achieving integrated, community-based EMS systems. Discusses health, safety, and wellness of the EMS workforce; education and certification; data and research; and workforce planning and development. Discusses rural and volunteer EMS workforce.
Author(s): Susan Chapman, Vanessa Lindler, Jennifer Kaiser
Date: 05/2011
Type: Document
Sponsoring organization: National Highway Traffic Safety Administration
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Rural Hospital Support for Emergency Medical Services
Discusses the proportion and characteristics of rural hospitals that support or operate EMS units, the financial investments made by these hospitals, and the communities in which these hospitals are located.
Additional links: Findings Brief
Author(s): Victoria A. Freeman, Hilda A. Howard, Ruth Lavergne
Date: 11/2010
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Rural Volunteer EMS: Reports from the Field
Explores the state of rural emergency medical services (EMS) by interviewing 49 local directors from all-volunteer rural services in 23 states.
Author(s): Victoria A. Freeman, Stephen Rutledge, Michael Hamon, Rebecca T. Slifkin
Date: 08/2010
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Improving Access to EMS and Health Care in Rural Communities: A Strategic Plan
Summarizes challenges in the emergency medical services field in rural areas and offers recommendations and goals to achieve solutions.
Date: 07/2010
Type: Document
Sponsoring organizations: Joint Committee of Rural Emergency Care, National Association of State EMS Officials, National Organization of State Offices of Rural Health
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Pediatric Care in Rural Hospital Emergency Departments
Analyzes data from the Emergency Pediatric Services and Equipment Supplement (EPSES) to the National Hospital Ambulatory Medicare Care Survey to compare rural and urban hospitals’ responses on various dimensions of pediatric Emergency Department care.
Additional links: Findings Brief
Author(s): Victoria A. Freeman, Randy K. Randolph, Stephanie Poley, Sarah Friedman, Rebecca T. Slifkin
Date: 05/2010
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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State Flex Program EMS/Trauma Activities and Integration of Critical Access Hospitals into Trauma Systems
Reports that more than one-third of all Critical Access Hospitals (CAHs) in the U.S. have been designated as trauma centers. The project team identified a combined total of 560 CAHs designated as trauma centers.
Additional links: Policy Brief
Author(s): Walter Gregg, Nicholas Jennings, Christopher Dickerson
Date: 03/2010
Type: Document
Sponsoring organization: Flex Monitoring Team
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Challenges for Rural Emergency Medical Services: Medical Oversight
Examines the challenges faced by rural emergency medical service agencies in recruiting a medical director and providing medical direction for EMS personnel.
Author(s): Victoria Freeman, Rebecca Slifkin, Daniel Patterson
Date: 05/2008
Type: Document
Sponsoring organization: The Cecil G. Sheps Center for Health Services Research
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Community-Based Needs Assessment: Assisting Communities in Building a Stronger EMS System
Outlines a community planning process for rural EMS systems that that engages local stakeholders to facilitate appropriate planning and decision-making at the local level.
Date: 2007
Type: Document
Sponsoring organization: Federal Office of Rural Health Policy
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The Role of the Rural General Surgeon in a Statewide Trauma System: The Wyoming Experience
Examines the role of general surgeons in Wyoming to demonstrate how important general surgeons are in rural trauma care.
Author(s): Blaine J. Ruby, Thomas H. Cogbill, Ronald S. Gardner
Citation: Bulletin of the American College of Surgeons, 91(4), 37-40
Date: 04/2006
Type: Document
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Model Trauma System Planning and Evaluation
Designed to provide trauma care direction to trauma care professionals, including public health officials and health care policy experts, when developing and evaluating trauma systems.
Additional links: Trauma System Self-Assessment Supplemental Tool: Benchmarks, Indicators, and Scoring
Date: 02/2006
Type: Document
Sponsoring organization: Health Resources and Services Administration
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Recruitment and Retention of a Quality Health Workforce in Rural Areas, Number 13: Emergency Medical Services
Discusses the challenges facing rural and frontier emergency medical services, including recruitment, financial issues, and training. Part of a series of issue papers addressing rural health care workforce development through career pipeline programs.
Date: 11/2005
Type: Document
Sponsoring organization: National Rural Health Association
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A Systems Development Guide for Rural Emergency Medical Services: A Systematic Approach to Generate Budgets for Rural Emergency Medical Services
A guidebook designed to help rural emergency medical services (EMS) systems with development, modification, consolidation, collaboration, system upgrades, administration, funding, as well as budgeting. Additional links include sample templates and worksheets.
Additional links: How to Use the EMS Budget Generator, Rural EMS Budget Generator
Type: Tool
Sponsoring organization: National Center for Rural Health Works
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FirstNet (First Responder Network Authority)
Provides information on the development of a national high-speed wireless broadband public safety network, supporting the work of first responders, including emergency medical services personnel.
Type: Website
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Fatality Facts: Urban/Rural Comparison
Presents characteristics and differences of fatal motor vehicle crashes between rural and urban areas, with trend data since 1977.
Type: Document
Sponsoring organization: Insurance Institute for Highway Safety: Highway Loss Data Institute
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Rural Trauma Team Development Course (RTTDC)
Provides a one-day course, focused on a team approach, for medical personnel who may respond to the initial evaluation and resuscitation of a trauma patient at a rural facility. Audience includes nurses, physicians, physician assistants, nurse practitioners, and other hospital personnel who may provide support.
Type: Website
Sponsoring organization: American College of Surgeons
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Quality Improvement Toolkit for Emergency Department Transfer Communication Measures
Shares recommendations and principles for facilitating safe and efficient transitions of care from the emergency department to other care settings. Discusses action plan considerations, provides education and training tips, and offers sample checklists, logs, and transfer forms, including samples from rural networks.
Type: Document
Sponsoring organization: Stratis Health
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Journal of Emergency Medical Services (JEMS)
Published monthly, this journal provides information and resources for EMTs, paramedics, EMS administrators, fire rescuers, public safety officials, and law enforcement officers. Includes numerous articles on rural EMS issues.
Type: Journal/Newsletter
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EMS Toolkit
Includes resources developed for rural EMS organizations, which are often run by volunteers. Topics include recruitment and retention, funding and finances, and leadership and management.
Type: Website
Sponsoring organization: Minnesota Department of Health - Office of Rural Health and Primary Care
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Joint Committee on Rural EMS Care (JCREC)
Formed jointly by the National Association of State EMS Officials (NASEMSO) and National Organization of State Offices of Rural Health (NOSORH). This Committee is dedicated to advancing policy to ensure access to timely, affordable, and high quality emergency care services in rural America.
Type: Website
Sponsoring organization: National Association of State EMS Officials
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PubMed Search: Emergency Medical Services and Trauma in Rural Areas
Searches PubMed's collection of journal article citations on the combined topics of emergency medical services, trauma, and rural health.
Type: Literature Search
Sponsoring organization: U.S. National Library of Medicine
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WISQARS (Web-based Injury Statistics Query and Reporting System)
An interactive database system that provides fatal and nonfatal injury, violent death, and cost of injury data from a variety of sources. Fatal injury data is available by metropolitan/nonmetro status in the Fatal Injury Reports section. Fatal Injury Mapping section provides access to county-level data.
Type: Database
Sponsoring organization: Centers for Disease Control and Prevention
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National Highway Traffic Safety Administration Emergency Medical Services (NHTSA EMS)
Contains educational opportunities, publications, news, and other emergency medical services resources, as well as background and updates on federal initiatives and programs. Includes information on the National EMS Advisory Council (NEMSAC).
Type: Website
Sponsoring organization: National Highway Traffic Safety Administration
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CMS Ambulances Services Center
Resources and information for Medicare ambulance services. Provides access to policies and regulations, fees and billing, manuals, educational opportunities, and more.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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Additional resources are available related to this guide. See the full list of resources by topic for:


Last Updated: 10/16/2018