According to the National Rural Health Association, across the United States, about 57 million people, or 18% of the total population, call rural communities’ home. Rural EMS services are more dependent on volunteers than their urban counterparts. A national survey of local EMS directors in rural and urban areas finds rural agencies were more likely to be staffed by volunteers only, (53% for isolated small rural vs. 14% for urban, see Figure 3). In some rural parts of the country (tending to be those more sparsely populated) it is estimated that volunteers cover more than 90 percent of EMS calls.
More than two-thirds (69%) of rural EMS directors surveyed in 2015, reported that they have a problem recruiting and/or retaining volunteers. When asked open-ended questions about staffing challenges, rural EMS directors cited:
- “The rural population base is small. There are few employers in many areas and many people work out-of-town, making it impossible for them to volunteer during the day.
- It is difficult to provide weekend coverage. There are too many competing demands for volunteers with families.”
Funding and reimbursement difficulties from third-party payers, along with low call volume, creates a situation in which many EMS providers in rural areas must rely upon all volunteer workforce to financially maintain operations. Recruitment and retention of trained personnel to serve on a volunteer basis can be a very difficult and inefficient process for EMS services in rural communities. Serving on a volunteer basis results in a situation in which the person must maintain other means of employment to meet their personal financial needs. While adopting and retainment is a major factor why EMS professions seek paid positions. Inconsistent funding in rural areas is also a contributing factor.
The cost per transport is higher in rural areas because the base costs of “maintaining readiness” are sunk costs, yet with lower volumes there is less of a funding stream to offset costs. Both low-volume and high-volume ambulance transports require up-to-date and maintained ambulance and crew. However, the increased volume in urban and suburban areas increases likelihood of recuperating of operational costs. As a downstream effect of lower volumes, rural ambulances have higher costs per transport and more associated bad debt.
Although rural areas typically experience fewer emergency events, adequate funding for equipment, staffing and training can be a major factor in the delivery of this much needed service. Reimbursement for EMS services are typically linked to call volume therefore it is common for rural EMS providers to depend heavily on volunteer Emergency Medical Technicians (EMTs) to meet staffing needs on a limited and fixed budget. While EMS professionals are needed everywhere. It is essential to solve the problem of attracting and retaining, and lower incoming revenue are reasons why it is essential that we have highly trained and skilled EMS professionals in rural areas.