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Studies examine Federal support and ways to measure available resources for emergency medical services in rural areas

Emergency medical services (EMS) systems provide emergency health care, rescue and safety services, and public health prevention activities to many communities. Several recently released reports have created a debate about the oversight and funding for EMS nationally. A recent commentary by P. Daniel Patterson, Ph.D., M.P.H., E.M.T.-B, of the University of North Carolina at Chapel Hill, examines how this debate affects the rural health community. A study by Dr. Patterson's group proposes a way to measure availability of EMS resources to identify under-resourced areas. Both were supported by the Agency for Healthcare Research and Quality (T32 HS00032) and are summarized here.

Patterson, P.D. (2006, Spring). "Emergency medical services and the Federal government's evolving role: What rural and frontier emergency medical services advocates should know." The Journal of Rural Health 22(2), pp. 97-101.

Federal support for the two main components of EMS, medical care and transportation, is currently spread across multiple agencies with diverse missions, agendas, and EMS budget commitments. A growing number of reports call for a greater Federal Government role in overseeing and funding EMS. The issue is being hotly debated among EMS, fire, rural health, and policy communities. Some EMS and fire service advocates feel Federal-level involvement should remain limited but be better coordinated, for example, by having Congress recreate the Federal Interagency Committee on EMS (FICEMS).

On the other side of the debate, different EMS constituents call upon Congress to create a U.S. Emergency Medical Services Administration (USEMSA). Advocates for a USEMSA argue that although EMS is equal in numbers to fire and police personnel nationwide, EMS has received very little support from agencies like the Department of Homeland Security. They point out that EMS lacks data collection programs and national training academies similar to its counterparts in public safety, and lacks a nationwide EMS needs assessment.

Policymakers have listened to the coalition supporting FICEMS, which includes rural EMS advocates, and support many of their recommendations. Bills have been introduced in both the Senate and House of Representatives that support a newly created FICEMS. It is unlikely that policymakers will support creating a USEMSA, asserts the author of this commentary. Factors like history, fragmentation of EMS, and current political philosophies suggest that the status quo in Federal-EMS relations is acceptable. Nevertheless, forward progress on FICEMS legislation holds promise for improving Federal programs and funding for EMS.

Patterson, P.D., Probst, J.C., and Moore, C.G. (2006, Spring). "Expected annual emergency miles per ambulance: An indicator for measuring availability of emergency medical services resources." The Journal of Rural Health 22(2), pp. 102-111.

This paper proposes a county-level indicator of EMS resource availability that estimates the minimum annual number of emergency miles placed on each ambulance in a county. The EXAMB (EXpected annual emergency miles per AMBulance) takes into consideration existing EMS resources (ambulances), population health and demographics, and geographic factors (land area). As such, it provides a basis for comparing ambulance availability across counties within States.

The researchers estimated ambulance demand using a rule of thumb that projected demand at 1 transport per 10,000 people per day, which many EMS systems still use as a rough estimate of future demand. To test the feasibility of the EXAMB indicator, they used county-level EMS data from five States in 2003. The EXAMB indicator was negatively correlated with ambulance availability per 100,000 population in 4 of the 5 States. The indicator was positively correlated with rurality in three States. In Mississippi, South Carolina, and Wyoming, whole-county health professional shortage areas had median EXAMB values 45-81 percent higher than those of counties without health professional shortages.

Although the EXAMB indicator was positively associated with rural status in three of the five States, it is possible for urban counties to have high EXAMB values if they have few ambulances, low physician-to-population ratios, high poverty rates, and high mortality rates. Given the reasons for high EXAMB values in various counties, local officials would have to decide the best response to them. This could range from policies that would reduce vehicular crash death rates to the purchase of new ambulances and programs to reduce poverty. The researchers suggest that the EXAMB indicator should be applied to more States.

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