Rural America has been experiencing a fundamental shift over the last decade regarding their emergency medical services (EMS) delivery and operations. Once largely independent of local government oversight, EMS organizations now find themselves in increasingly difficult situations due to a combination of factors.
Historically, most volunteer rescue squads have operated largely independent of public oversight or funding. However, as they struggled to cover calls, county governments have been forced to take a larger role. Montgomery County in Virginia, for example, created a new agency with 24/7 paid coverage to supplement EMS in areas where volunteer agencies struggled to provide reliable service.
This shift has brought about tough decisions for county leaders, who must navigate the delicate state of volunteer participation, new funding requirements, patient billing, and other issues that are relatively new to many rural county governments. Some of the “big picture” questions county leaders will face include:
- Should we hire outside experts/consultants to evaluate our current operations?
- How can we balance the participation of volunteers while ensuring EMS is operational 24/7?
- What billing practices (e.g., soft billing) should our agencies adopt?
- Will our wages be competitive enough to limit turnover and retain providers?
- Can we utilize any existing resources (ambulances, facilities, etc.) to help reduce costs?
- What is the best way to engage the community in this process?