Rural EMS Infrastructure
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.