Emergency Medical Service (EMS)

This collection of resources is intended to help rural EMS services adapt to and become a more integrated part of the evolving health care system.

Prior to the early 1970s and the advent of modern emergency medical services (EMS), ambulance services were mainly sources of transportation for the emergently ill and injured. EMS, as we know it today, is often referred to as “EMS 2.0”. While EMS is geared toward intervening in high acuity and other injuries and medical emergencies, a significant portion of the patients it is called to help do not have an emergency of this sort. EMS has continued to be largely funded on a fee-for-service basis, and mainly for transportation.

Currently, the health care industry is undergoing profound change, moving away from dependency on fees assessed for the volume of services provided and toward a people-centered, value-based operation that rewards positive patient outcomes. Transformation to a next evolutionary stage is necessary if EMS is to thrive and play an integral part in the changing health care system. 

This collection of resources is intended to help rural EMS adapt and become a more integrated part of the evolving health care system.

Resources below are grouped into the following categories:

EMS Transformation and Organizational Stability Resources

This 2019 document from the National Highway Traffic Safety Administration's (NHTSA) Office of EMS describes is a strategic map for a people-centered EMS evolution consistent with rural community EMS agency transformation to value and population health. It describes a vision for evidence-based, data-driven integrated EMS.

EMS 3.0 is an EMS industry initiative to help EMS agencies and practitioners understand the changes that are needed in EMS to fully support the transformation of our nation’s health care system and to provide tools and resources to help them implement these changes.

This 2019 publication funded by the NHTSA Office of EMS has over 250 recommendations for creating environments conducive to innovation. Many of the local agency recommendations would enable improvements leading to EMS transformation.

This report is designed to help rural EMS leaders and health care providers during the transition to value-based payment, providing ideas for collaboration and potential strategies to better prepare and integrate into the new value-based environment.

This guide is designed to assist rural communities in navigating a change from unsustainable volunteer EMS and ambulance service models to those that are sustainable. It includes information on how to assess if a community has an EMS problem and a six-step process to implement change.

Assess the core competencies of a rural ambulance agency to provide broader service and greater value patient care and access in rural America. This self-assessment and associated resources will assist rural ambulance agency leaders to succeed with moving from volume to value in their agency’s culture and operations.

This article discusses the concept of Informed Community Self-Determination (ICSD) in EMS. It is thought to be a useful tool to evaluate the community’s EMS, informing the community of current capability and limitations (costs, staffing), establish options for change, and inform the community of the relative costs of those options.

The Wisconsin Office of Rural Health convened a national group of EMS leaders to create a mechanism to assess the capacity of Ambulance Services. The goal was to create an assessment instrument that could be used on the levels of individual ambulance services, state agencies and organizations and federal agencies. With that in mind, 18 “Attributes of a Successful Rural Ambulance Service” were identified. Two resources were developed as a result, one to assess performance and one to aid improvement.

Various examples of assessments created by state Flex Programs to assess statewide EMS. 

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California Flex Program EMS Assessment

California Flex Program

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Washington Flex Program

This practical guide is for ambulance agencies to use in pursuit of sustaining effective and efficient delivery of patient care and developing into an integrated system with other agencies. It provides various examples that have been used by agencies to benefit them, their staff, and most importantly, their patients.

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EMS Spotlight Videos

In this video, one rural ambulance service shares the value realized in reporting and using data to improve organizational culture. They share their enhanced ability to identify improvement opportunities that move the needle on health outcomes for their patients, such as CP and an antibiotic protocol for sepsis.

Learn how one county in Iowa, with three independent ambulance services and one hospital-based ambulance service, completed a multi-year process to address their broken EMS system using Flex Program funding. The funding allowed them to complete a project by gathering stakeholders, considering all options, and choosing the best approaches to ensure consistent and quality patient care for their county. They also used the funds to engage and educate their communities about the cost and value of EMS, resulting in taxpayer approval of funds to offset the annual cost of operation.

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Community Paramedicine Information and Guides

This report incorporates the proceedings of the 2021 Rural Community Paramedicine (CP)  Summit, as well as a list of key strategies for implementing and sustaining CP in rural communities. It also contains resources, established CP programs, and information about how state Flex Programs can support rural CP efforts.

This resource includes a compilation of cited references that describe the impact of previously implemented CP initiatives. Those considering CP systems can review results as applicable to their initiative and use the information to inform implementation.

View the summary of a 2018 survey conducted with over 200 known Community Paramedicine-Mobile Integrated Health (CP-MIH) agencies in the country exploring many aspects of their operations including outcome and impact measurement and the development of relationships with communities served and with key partners and stakeholders.

This document summarizes the resources paramount in the development of CP in Abbeville, South Carolina. The Blueprint is specific to South Carolina and is geared towards EMS agencies, but is a useful toolkit for other states interested in starting the journey of implementing a CP program.

Helpful tools and resources to be used by varied stakeholders but primarily prospective employers interested in hiring and integrating a CP into their organization. The tools are intended to be both actionable and measurable and will help streamline an employer’s decision-making while adopting a CP program in Minnesota.

The handbook is designed to be a comprehensive resource for use by paramedic services or a community as a planning guide to develop a CP program. The appendix contains forms and tools that can be used throughout the process and after the beginning of operations.

The Florida Department of Health has published the Florida Mobile Integrated Healthcare Community Paramedicine Program (MIH-CP) Guidebook, designed to take readers through the research, analysis, planning, development, and successful launch of a customized MIH-CP program. It provides recommendations and lessons learned from MIH-CP programs in Florida, advice from experts across the country, and expanded resources and templates.

View a toolkit of resources that outlines how to implement a CP program in 12 steps from conducting background research to beginning all the way through evaluating the implemented program.

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EMS Policy Resources

Since the beginning of the COVID-19 Public Health Emergency,  the Centers for Medicare and Medicaid Services (CMS) has issued an array of temporary regulatory waivers and new rules to equip the American health care system with maximum flexibility to respond to the COVID-19 pandemic. This fact sheet outlines the flexibilities specifically for ambulances.

This Rural Policy Research Institute Health Panel (RUPRI Health Panel) policy paper examines current rural ambulance agency characteristics and challenges and identifies public policy considerations designed to stabilize rural ambulance agencies.

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Foundational Rural EMS Documents

The EMS Agenda for the Future, published in 1996, provided an opportunity to examine what had been learned during the past three decades and create a vision for the future. This document focused on aspects of EMS related to emergency care outside traditional health care facilities.

This 2004 publication was a visionary strategic roadmap in the model of the 1996 EMS Agenda for the Future but intended to specifically shape rural EMS. It provides over 120 recommendations, some of which can shape local agency transformation during strategic planning initiatives.

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