Rural emergency medical services (EMS) agencies face continual challenges to ensure a trained workforce to meet the prehospital emergency care needs of their communities. A reliance on volunteer emergency medical technicians (EMTs) with decreasing volunteerism in rural areas has forced some EMS agencies to close and others to consider changes in organizational structure and affiliation with other agencies.

Hospital-based EMS/ambulance services could offer many advantages and possible solutions to the problems facing rural EMS today. This two-part project will explore trends in provision of EMS/ambulance services among hospitals and the factors considered by hospital administrators in their decisions to acquire, maintain, or discontinue ambulance service.

In part 1 of the proposed study, secondary data will be used to describe the portion of rural hospitals currently providing EMS/ambulance services, and how that proportion compares to hospitals located in urban areas. The proportion of hospitals that have acquired EMS/ambulance services in the past year and that have discontinued these services will also be identified, as well as characteristics associated with these changes. Information obtained from this classification of hospitals will be used to inform the selection of twelve hospitals for further study using in-depth interviews with hospital administrators and possible others. One hospital in each category (ongoing provision of EMS/ambulance, new provider of EMS/ambulance, and discontinued provision of EMS/ambulance) will be chosen from each U.S. Census region. A structured interview protocol will be developed to explore those factors assumed to be important in a hospital's decision to offer ambulance services, e.g., reimbursement for services, impact on hospital staffing, and availability of ambulance services in the area. In addition, open-ended questions will be included to allow hospital officials to explain in detail other considerations that may not be obvious to the researchers. Results of the study will be used to recommend areas for further research and programs and/or policies to support provision of prehospital emergency care in rural areas.

Publications

• Rural Hospital Support for Emergency Medical Services (Final Report)
  North Carolina Rural Health Research and Policy Analysis Center
  Date: 11/2010
  This report shares information on rural hospitals related to these questions: what proportion support/operate emergency medical services (EMS) units; has this changed; what are the characteristics of the hospitals that support/operate EMS; what investments were made in EMS; and what describes the communities where the hospitals are located?
• Rural Hospital Support for Emergency Medical Services (Findings Brief)
  North Carolina Rural Health Research and Policy Analysis Center
  Date: 11/2010
  This study looked at rural hospitals to answer these questions: what proportion support/operate emergency medical services (EMS) units; has this changed; what are the characteristics of the hospitals that support/operate EMS; what financial investments were made in EMS; and what describes the communities where the hospitals are located?