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Rural Health Care: Challenges & Opportunities

Emergency Medical Services


Barak Wolff, Director, Public Health Division, New Mexico Department of Health, Santa Fe, NM.

Mr. Wolff highlighted major health challenges, limitations, and directions of emergency medical services (EMS) in rural areas:

  • Fragmented leadership at Federal, State, local, and professional levels.
  • Volunteer dilemma (moving toward paid service, but not in rural areas).
  • Training and education of EMS personnel.
  • Lack of adequate EMS education programs in many areas.
  • Need to establish collaborative relationships between EMS education programs and academic institutions.
  • Need to include EMS-related objectives in all health professions' education.
  • Inadequate support for basic infrastructure (e.g., obtaining vehicles and equipment).
  • Need to commit local, State, and Federal attention and funds to continued EMS infrastructure development.
  • Need to appropriate sufficient resources for EMS medical direction.
  • Develop collaborative research relationships among EMS systems, medical schools, other academic institutions, and private foundations.
  • Need to collaborate with community agencies and health care providers regarding injury prevention and public health.

Mr. Wolff explored related policy issues and identified major roles by the national, State, and local governments in regulating and providing EMS services. Policy and leadership decisions for the future of rural EMS include:

  • Change the EMS culture from saving lives to being community health partners, which involves public health initiatives such as immunizations, child car seats, and substance abuse prevention.
  • Support leadership and management development for EMS personnel.
  • Support reimbursement for prevention and services, as well as transportation.
  • Develop strategies for basic infrastructure resource support.
  • Support EMS-related research.

EMS is a critical part of the rural health safety net. The vision of the future is integration with other health services, a continuum that includes public health and prevention, primary care and home health care, and hospitals and rehabilitation services. Integration of EMS with other components of the health care system involves:

  • Expanding the role of EMS in public health.
  • Involving EMS in community health monitoring.
  • Integrating EMS with other health care providers and provider networks.
  • Incorporating EMS within health care networks' structure to deliver quality care.


Callaham M. Quantifying the scanty science of prehospital emergency care. Ann Emerg Med 1997 Dec;30(6):785-90.

Emergency Medical Services: Agenda for the future. DOT HS 808 441, 1996 August, NTS-42.

Marcum L. The not-so-scientific value of EMS. Letter to the Editor. Ann Emerg Med 1998 Nov;32(5):634-6.

National Rural Health Association. Rural and Frontier Emergency Medical Services Toward the Year 2000. NRHA Issue Paper. 1997 May.

Wolff B. An expanded vision for EMS. Emergency 1994 June;9.

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