For acute illness and trauma, Emergency Medical Services (EMS) response is crucial. In rural areas, greater distances already result in reduced survival probabilities for rural residents. Any loss of EMS services would increase rural urban disadvantages. The Medicare Ambulance Payment Reform Act of 2001 (S.1350/HR.3109) and the Medicare Rural Ambulance Relief Act of 2001 (S.1367) have been recent attempts to improve the infrastructure of EMS systems nationwide. However, these solutions may not apply equally well to differently structured EMS systems and across rural areas. Variation in local EMS structure is considerable. In South Carolina, we identified three modes: hospital supported, county supported (tax base), and volunteer supported (donations). Representatives of the National Association of State EMS Directors identified other structures, including joint fire - rescue squads and "ranch squads," a form of volunteer EMS found in frontier counties. The total range of organizational forms for prehospital emergency providers and the geographic distribution of these structures is not known. A county-by county census of the types of EMS infrastructure present would allow the development of a typology of rural EMS programs that could be used to identify at-risk types and areas.

Publications

• Expected Annual Emergency Miles per Ambulance: An Indicator for Measuring Availability of Emergency Medical Services Resources
  Journal Article
  Rural and Minority Health Research Center
  Date: 04/2006
  Proposes a county-level indicator of emergency medical services (EMS) resource availability that takes into consideration existing EMS resources, population health and demographics, and geographic factors. The indicator, the expected annual emergency miles per ambulance, provides a basis for comparing ambulance availability across counties.
• Investigating Rural EMS Infrastructure: A Developmental Methodology for Measuring the Availability of EMS Resources
  Rural and Minority Health Research Center
  Date: 08/2004
  This report explores a potential indicator of emergency medical services availability, the Expected Annual Emergency Miles per Ambulance (EXAMB). The EXAMB measure calculates expected annual emergency miles per ambulance beginning with the number of ambulances, the land area of a county as a proxy for distance, and county population.