This study uses a survey of all ground-based prehospital
emergency medical services (EMS) agencies in nine states
(AR, FL, KS, MA, MT, NM, OR, SC, WI) to examine supply
and demand for emergency response personnel, the
involvement of medical directors, and the availability of
medical consultation, in rural and urban agencies.
Compared with urban EMS agencies, rural agencies had
lower staff skill levels, higher reliance on volunteers,
higher vacancy ratios, and less access to oversight and
skill maintenance through regular interaction with a
medical director and online medical consultation during
emergency calls. Agencies in isolated small rural areas
were the most distinct from other rural and urban
agencies, having the most volunteers (both EMS providers
and medical directors) and paid staff vacancies.