Resources: Emergency Medical Services (EMS)

State Flex Programs are required to address EMS improvements and play a part in bringing about positive changes in rural communities' EMS systems. State initiatives include needs assessment, training, recruitment & retention, and addressing funding/reimbursement.

        Tools Resources         Organizations         Funding

Tools

Agency Interview Survey
Assessment to gauge recruitment and retention efforts in rural EMS.

Ambulance Services Networking Initiative
This tool, developed by the South Dakota Department of Health, Office of Rural Health, is used to identify ambulance services and prioritize assistance based on need in order to improve the statewide ambulance network.

EMS-CAH Network Agreement
This document is at network agreement between a critical access hospital and an EMS provider.

EMS in the FLEX Program 2008-2010: EMS Medical Direction
This EMS document outlines the following suggested activity: Sponsor tuition for completion of a national standard medical direction course delivered over the internet.

EMS in the FLEX Program 2008-2010: EMS Recruitment/Retention, Reimbursement and Restructuring
This document outlines suggested activities for the following:

1. Promote the replication of evidence based recruitment and retention programs
2. Support personnel in establishing comprehensive budget planning processes
3. Encourage the use of group purchasing and billing services
4. Support EMS agencies in completing assessments and strategic business planning
5. Support EMS leadership-specific training
6. Support the exploration of EMS-based community healthcare models

EMS in the FLEX Program 2008-2010: State Strategic Planning: Trauma System
Suggested Activities:
1. Designate CAHs as Level III, IV, or V Trauma Facilities
2. Strategic Planning based on the Trauma-BIS Assessment or Trauma System Consultation

EMS in the FLEX Program 2008-2010: Trauma System Assessment and Development
Suggested Activities for the utilization of HRSA's Model Trauma System Planning and Evaluation (MTSPE) benchmark, indicator and scoring (BIS) system (Trauma-BIS) and for the application of the American College of Surgeons (ACS) Facilitated Trauma System Consultation program.

EMS in the FLEX Program 2008-2010: Trauma Team Training
This document details suggested activities on how to sponsor tuition for RTTDC or CALS courses conducted for CAHs.

EMS Instructor Observation Protocol
This document from the Nebraska Office of Rural Health is an example of a survey that could be given to EMT students to evaluate EMS Training Programs.

Measuring Success Through Quality Improvement
This quality improvement plan, developed by the Nebraska Health and Human Service System, is intended to foster an improved relationship between hospitals and EMS providers, using a systematic approach.

Mentoring Program Proposal
This proposal from the Nebraska Office of Rural Health describes how an EMS Mentoring Program could be established.

Successful EMS Projects Conducted By State Offices of Rural Health under the Medicare Rural Hospital Flexibility Program
Addressing emergency medical services (EMS) in rural areas is a core component of the Medicare Rural Hospital Flexibility Program (FLEX). A number of external and internal factors vary the degree of difficulty for individual state offices of rural health to determine appropriate tasks in their grant planning.

Surveys

Following are several examples of EMS service surveys used in State Flex Programs. Each has been designed gather information about local EMS providers and identify areas for improvement in emergency services in rural areas.

  • Ambulance Service Survey
    This survey, developed by the Minnesota Office of Rural Health & Primary Care's Rural Ambulance Services work group, covers staff, current operations, finances, and infrastructure.
    • Cover Letter for Ambulance Survey
      This letter is designed to accompany the Ambulance Survey. It can be modified to include appropriate names and contact information for any state.
  • Arizona EMS Needs Assessment
    This extensive survey, developed by the State of Arizona Rural Health Office, Family and Community Medicine department, was used to identify communities in need of support. The information will be used to assist in establishing EMS-related priorities for the CAH program.
  • EMS Provider Survey and EMS Squad Survey
    These surveys were prepared by the Rural EMS Institute in collaboration with the North Dakota State Office of Rural Health, and the State EMS Office. If you use either of them, please send feedback to Deb Moreno for continuous improvement purposes.
  • Idaho EMS Bureau Technical Assessment Survey
    This survey, developed by the Idaho Department of Health and Welfare, Office of Rural Health and Primary care, was used to gather basic information from area providers using common EMS standards.
  • Nebraska EMS Survey
    This project report, developed by the Nebraska Center for Rural Health Research, addresses EMS organization, personnel, equipment, services, funding, recruitment and retention, community recognition, education, and training. Survey Questions are list in Appendix B. The report (PR 01.6) is located under the category "Projects and Special Reports."
  • Oregon EMS Survey
    This survey, developed by the Oregon Health and Science University, Office of Rural Health, was used to gather basic information about emergency medical service in the state.
  • Rural Emergency Medical Services Survey
    This survey, developed by the Florida Department of Health, Office of Rural Health, has been used to help establish priorities for Flex funds in the EMS area.
  • South Carolina State EMS Survey
    This survey was developed for the South Carolina State Office of Rural Health to begin to gather basic information about emergency medical services in the state.

Resources

Ambulance Benchmarking Project
The North Central EMS Institute is in the process of developing benchmarks for the ambulance industry. If you would like to participate in this process, please visit this site. The site also contains information on EMS funding issues.

Capital Area Rural Health Roundtable
  • This newsletter addresses rural EMS financial issues.
  • This paper summarizes rural ambulance economics.

CMS Proposed Rule Change for Ambulance Reimbursement Maps
CMS ambulance reimbursement maps showing how CMS's proposed rule, the CBSA definition of rural, will impact ambulance reimbursement.

Emergency Medical Services in Rural America, June 2007
NCSL convened a day-long conference in April 2007 to inform policymakers about the challenges facing emergency medical service providers in rural America. The meeting brought together experts from around the country who presented promising state strategies and highlighted ways that states are strengthening the EMS "system"–the people delivering care, the resources that help providers deliver care effectively and efficiently, and the partnerships among caregivers and facilities that help to fill gaps in services. This report summarizes the conference and highlights important information.

EMS Definition of Rural
The EMS Report was created through the efforts of Gary Wingrove, Manager, Mayo Clinics Gold Cross Ambulance Service and Thomas Judge, Executive Director, Lifeflight of Maine. It was developed for, and included in the final Rural Emergency Medical Service Agenda for the Future. The following maps were produced by the Rural Policy Research Institute under contract with the American Ambulance Association. Reprinted with permission:

EMS Sex Ed Program Reduces Rural Pregancy Rate
This article from "Best Practices in Emergency Services" tells of an initiative in a rural community in Tennessee where the EMS service has begun providing sex education to area high school students.

Rural and Frontier EMS Agenda For the Future
This document by Kevin K. McGinnis, MPS, WEMT-P with assistance from the National Rural Health Association, contains goals to meet the needs of rural communities, resources already in place, what needs to be done, and what needs to be funded to make EMS work in rural communities.

Rural Communities and Emergency Preparedness
This report, prepared by the Office of Rural Health Policy, addresses rural emergency preparedness by describing the rural public health infrastructure and an overview of rural emergency preparedness as well as perspectives and experiences of State Offices of Rural Health in responding to emergencies and in enhancing responsiveness in their States' rural communities.

Rural Health EMS System Review

Survey of Critical Access Hospital - Affiliated Emergency Medical Service Providers, Penny Mohr, Senior Research Director, Project Hope Welsh Center for Rural Health Analysis
This recently released survey details the findings of a survey of rural EMS providers that serve Critical Access Hospital Communities.

Organizations

Rural EMS and Trauma Technical Assistance Center (REMSTTAC)