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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.

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), shows 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, the factors that affect service, and actions the federal government could take to provide pricing oversight. Discusses the implications and importance of air transport for rural areas throughout.
Date: 07/2017
Type: Document
Sponsoring organization: Government Accountability Office
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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 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
Location: BMJ, 356(j239)
Date: 02/2017
Type: Document
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Traffic Safety Facts 2015
Presents rural versus urban data on fatal crashes by state and the average emergency medical service (EMS) response times.
Date: 2017
Type: Document
Sponsoring organization: National Highway Traffic Safety Administration
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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. 60 minutes.
Additional links: 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
Location: 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.
Location: 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.
Location: 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
Location: 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
Location: Western Journal of Emergency Medicine, 16(4), 594-599
Date: 07/2015
Type: Document
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EMS Office Assessment of the Status of Community Paramedicine/Mobile Integrated Healthcare in the States and Territories
Results of a survey of 49 National Association of State EMS Officials (NASEMSO) member states and territories, documenting existing or planned programs. Features statistics on reimbursement strategies, involvement of hospitals/health systems, state legislation, certification, medical direction, community health assessments, and use of quality improvement measures.
Date: 05/2015
Type: Document
Sponsoring organization: National Association of State EMS Officials
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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 an incident that occurred in a rural valley, where 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
Location: 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. This appears to be the first systematic assessment of IHS EMS on children's services.
Author(s): Andrea Genovesi, Betty Hastings, Elizabeth Edgerton, Lenora Olson
Location: 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
Location: Rural and Remote Health, 14, 2690
Date: 05/2014
Type: Document
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Blueprint for Community Paramedicine Programs Especially for EMS Agencies
Describes implementation of a Community Paramedicine program in Abbeville, South Carolina, and identifies ways that emergency medical technicians may expand their roles in order to bridge healthcare gaps in rural areas. Includes strategies for program promotion and evaluation.
Date: 03/2014
Type: Document
Sponsoring organization: South Carolina Office of Rural Health
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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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Improving Rural Health: State Policy Options
Discusses strategies that states have used to improve healthcare in rural communities. Covers workforce pipeline initiatives, long-term care services, behavioral health, emergency medical services, wellness and prevention, rural health clinics, school-based health centers, telehealth, recruitment and retention of healthcare professionals, loan repayment programs, and community health workers.
Author(s): Kristine Goodwin, Laura Tobler
Date: 11/2013
Type: Document
Sponsoring organization: National Conference of State Legislatures
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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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Health, United States, 2012: With Special Feature on Emergency Care
Presents an annual overview of national trends in health statistics. Uses charts to present information on a variety of health issues and measures including rural and nonmetropolitan areas.
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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Rural States Struggle to Reduce Road Deaths
Reports that rural roads are more dangerous than urban due to a number of factors. These include people drive faster in rural areas, crashes are more deadly, rural drivers tend to be older, and hospitals are farther away, resulting in longer response times.
Author(s): Daniel C. Vock
Date: 03/2013
Type: Document
Sponsoring organization: Pew Charitable Trusts
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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
Location: Rural Monitor, 2012(Summer)
Date: 08/2012
Type: Document
Sponsoring organization: Rural Health Information Hub
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Local and National Efforts Improve Rural EMS Safety
Highlights EVENT, a national web-based reporting tool. Discusses how new, 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
Location: Rural Monitor, 2012(Summer)
Date: 08/2012
Type: Document
Sponsoring organization: Rural Health Information Hub
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Telemedicine Consultation for Emergency Trauma: The 130 Million Square Foot Trauma Room
Describes the implementation and evaluation of a teletrauma network in rural Maine where specialists provide care remotely, improving care outcomes for rural areas.
Author(s): Rafael J. Grossmann Zamora, Barbara Sorondo, Robert Holmberg, Pret Bjorn
Location: Bulletin of the American College of Surgeons, 96(6), 12-19
Date: 06/2012
Type: Document
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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
Location: Rural Monitor, 2011(Fall)
Date: 11/2011
Type: Document
Sponsoring organization: Rural Health Information Hub
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Safety in Numbers: Are Major Cities the Safest Places in the United States?
Compares injury risk in urban areas to those in suburban and rural areas. Reports that death rates for injury are higher in frontier and rural areas.
Author(s): Sage R. Myers, Charles C. Branas, Benjamin C. French, Michael L. Nance, et al.
Location: Annals of Emergency Medicine, 62(4), 408-418
Date: 10/2011
Type: Document
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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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The Rural EMS Crisis: An Interview with Gary Wingrove
An interview with former Minnesota State EMS Director Gary Wingrove about the problems faced by rural EMS systems.
Author(s): Raphael Barishansky
Date: 01/2011
Type: Document
Sponsoring organization: EMS World
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A Novel Emergency Medical Services-Based Program to Identify and Assist Older Adults in a Rural Community
Describes a program using EMS providers to screen older adults for common geriatric syndromes and provide referrals to case managers and community resources.
Author(s): Manish N. Shah, Thomas V. Caprio, Peter Swanson, et al.
Location: Journal of the American Geriatrics Society, 58(11), 2205-2211
Date: 11/2010
Type: Document
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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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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 the Trauma System (Policy Brief)
Reports that more than one-third of all Critical Access Hospitals in the U.S. have been designated as trauma centers. The project team identified a combined total of 560 CAHs designated as trauma centers.
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: 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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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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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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Attributes of a Successful Rural Ambulance Service
Draft of a survey created by a national group of State Office of Rural Health and State EMS directors, designed for states to assess their emergency medical services. Provides information to improve performance for each attribute rated.
Type: Website
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The Freestanding Emergency Department Financial Assessment Strategic Tool (FED FAST)
Provides a means to evaluate the financial feasibility of transforming a rural hospital into a rural freestanding emergency department (RFED) in high, medium, and low volume settings.
Type: Tool
Sponsoring organization: North Carolina Rural Health Research Program
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FirstNet (First Responder Network Authority)
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
Provides resources on principles of care transitions from the emergency department to another care setting to improve communication and patient care coordination. Provides action plans, education and training, 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: 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 Fee-for-Service (FFS) ambulance suppliers. 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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Last Updated: 12/11/2017