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

Tools

Agency Interview Survey
Oregon Office of Rural Health
Assessment to gauge recruitment and retention efforts in rural EMS.

Ambulance Services Networking Initiative
South Dakota Department of Health, Office of Rural Health identifies ambulance services and prioritizes assistance based on need in order to improve the statewide ambulance network.

EMS-CAH Network Agreement
Technical Assistance and Services Center (TASC)
A network agreement between a critical access hospital and an EMS provider.

EMS in the FLEX Program 2008-2010: EMS Medical Direction
Technical Assistance and Services Center (TASC)
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
Technical Assistance and Services Center (TASC)
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
Technical Assistance and Services Center (TASC)
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
Technical Assistance and Services Center (TASC)
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
Technical Assistance and Services Center (TASC)
Details suggested activities on how to sponsor tuition for RTTDC or CALS courses conducted for CAHs.

EMS Instructor Observation Protocol
Nebraska Office of Rural Health
Example of a survey that could be given to EMT students to evaluate EMS Training Programs.

Measuring Success Through Quality Improvement
Nebraska Health and Human Service System
Explains how to foster an improved relationship between hospitals and EMS providers, using a systematic approach.

Mentoring Program Proposal
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
Technical Assistance and Services Center (TASC)
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 to gather information about local EMS providers and identify areas for improvement in emergency services in rural areas.

  • Ambulance Service Survey
    Minnesota Office of Rural Health & Primary Care's Rural Ambulance Services 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
    State of Arizona Rural Health Office, Family and Community Medicine Department
    Identifies communities in need of support. The information can be used to assist in establishing EMS-related priorities for the CAH program.
  • EMS Provider Survey and EMS Squad Survey
    Rural EMS Institute in collaboration with the North Dakota State Office of Rural Health, and the State EMS Office
    Surveys used to improve the performance of an EMS squad.
  • Idaho EMS Bureau Technical Assessment Survey
    Idaho Department of Health and Welfare, Office of Rural Health and Primary Care
    Basic information from area providers using common EMS standards.
  • Nebraska EMS Survey
    Nebraska Center for Rural Health Research
    Addresses EMS organization, personnel, equipment, services, funding, recruitment and retention, community recognition, education, and training. Survey Questions are listed in Appendix B.
  • Oregon EMS Survey
    Oregon Health and Science University, Office of Rural Health
    Basic information about emergency medical service in the state.
  • Rural Emergency Medical Services Survey
    Florida Department of Health, Office of Rural Health
    Establish priorities for Flex funds in the EMS area.
  • South Carolina State EMS Survey
    South Carolina State Office of Rural Health
    Survey used to gather basic information about emergency medical services in the state.

Resources

Ambulance Benchmarking Project
North Central EMS Institute
The site contains information on EMS funding issues.

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
National Conference of State Legislatures
Information to 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.

EMS Definition of Rural
Gary Wingrove, Manager, Mayo Clinics Gold Cross Ambulance Service and Thomas Judge, Executive Director, Lifeflight of Maine
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 Pregnancy Rate
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.

EMS Workforce for the 21st Century: A National Assessment
National Highway Traffic Safety Administration
Describes the national EMS workforce, while also elucidating the absence of consistent, nation-wide EMS workforce data. Currently, the assessment is being used to guide development of the EMS Workforce Agenda for the Future, a document that will establish a vision for the future of the nation's EMS workforce. Information on this ongoing project is available at http://www.emsworkforce.com.

Experiences of Critical Access Hospitals in the Provision of Emergency Medical Services (Policy Brief)
Rural Health Research and Policy Centers
Presents NORC Walsh Center for Rural Health Analysis research conducted to better understand the experiences of CAHs in operating an EMS unit. Using key informant interviews, researchers examined motivations for acquiring EMS services and the effect of these services on the level of emergency care available in the community. The benefits and challenges that CAH providers face in operating EMS services are discussed.

Rural and Frontier EMS Agenda For the Future
Kevin K. McGinnis, MPS, WEMT-P with assistance from the National Rural Health Association
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
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
Data intended to indicate the standards of EMS in New York State as well as comparisons to like organizations nationally. Specific attention placed on the rural areas and compared to the "best practices" of like organizations.

Survey of Critical Access Hospital - Affiliated Emergency Medical Service Providers
Penny Mohr, 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)
REMSTTAC is dedicated to supporting EMS, trauma and rural health policy makers, EMS agencies, EMS professionals and the communities they serve to help ensure that vital EMS and trauma services can continue to survive and thrive in rural and frontier communities.