Losing Rural Lives to American Ambulance Deserts

We all do it. Maybe you’re working at a construction site and need to call for help due to a misplaced connection that drops a pile of 2X4s on a coworker. Or you’re sitting at a park when a loose dog bites the arm of a kiddo on the playground, causing blood loss and requiring immediate medical attention.

No matter the scenario, we spend our lives resting easy knowing that an ambulance is only a quick 911 call away. Sounds perfect right? So what happens when you’re living in a rural community with one or two ambulances on staff, and both are busy? How do you get the help you need when the only resources around are busy helping someone else?

Local EMS agencies (fire trucks, private/volunteer teams, and ambulances) respond to roughly 28.5 million 911 dispatches every year across 41 states. While most of our population lives in big cities where you cannot throw a stone without hitting a Starbucks or nearby medical center, the rest of the country is in rural communities. In those areas, it isn’t uncommon to have no more than two ambulances serving a 20,000-person population across a 25–45-mile area.

In even the best situation, the average time it takes to cover 25 miles is 30 minutes. That can feel like an eternity when you’re watching your brother whimpering in the corner because of an overdose.

There are over 46 million U.S. residents living in rural designated areas. That is about 14% of the total population relying on a single ambulance dispatch to care for their needs. These areas are known as “ambulance deserts” because there is a single point of contact to transport medical emergencies from homes, schools, workplaces, and hiking trails to nearby hospitals.

We consider anyone living 25 minutes or more from an ambulance center to be within an ambulance desert. In a recent study by the Maine Rural Health Research Center, they found that 4.5 million people lived in these deserts. Six out of the ten states discovered resided in the south, with Alabama taking the lead, underserving 315,000 people, and North Carolina a close second.

Why is this happening? Government agencies, private companies, and volunteer groups primarily provide ambulance and medical services. That last category has experienced a massive shift in recent years. “There has been a strong decline in the number of people available to be providing voluntary services in rural communities,” according to an interview with Nick Nudell, president of the American Paramedic Association.

The reality is our volunteer base is “aging out,” with most participants being in their 60s or 70s. Younger people are not volunteering in rural areas because they are moving to more populated regions where services are readily available.

To put that in perspective, on a recent episode of Last Week Tonight with John Oliver, the host pointed out how broken our US EMS services are. Between underpaid emergency responders and a fragmented or underfunded collection of departments, the general public is often on the hook for massive surprise bills that patients cannot pay.

Here’s the challenge. Say you’re having a heart attack, and you call 911. You’re lucky. The ambulance comes within 10 minutes. As they work on you, other secondary procedures and equipment are used. Of course, you’re in the middle of an attack and cannot be lucid enough to speak up on your behalf. Even when EMS providers are doing everything they think appropriate, you are left with staggering medical bills.

People in rural areas tend to make less than those in cities. Rising costs for medical aid can make the difference between keeping your home or not. As of 2021, 58% of debts recorded in collections were related to a medical bill. When you are faced with thousands in medical bills or having your next-door neighbor rush you to the local grocery store for a baby aspirin so you can muscle through another heart attack, guess which option you’re going to choose.

So, now we have a blended situation — a perfect storm — where people don’t want to pay for extremely overpriced services, the government cannot fund a universal system, and there aren’t enough volunteers to make up the difference. What is the result? Over 600 rural hospitals, about 30% of the total rural hospitals nationwide, are at risk of closing in the near future. We don’t have the money, people, or resources to keep them open, and the rural community is going to suffer the most significant hit.

There is no guaranteed way to fix the problem of rural ambulance deserts. It will take a combination of different initiatives to ensure we have the medical teams and aid needed to help our population. To start, we need to pay volunteers and EMS staff more. If these jobs are viewed as viable careers, we can attract more younger and better-trained professionals to the field. That would include incentives for recent graduates.

Next, we need to look at government funding. Partnerships with private hospitals are fine, but they cannot provide the full breadth of services required to serve such a varied population without the appropriate allocation of available funds. That funding should include an increase in remote appointments. Having more access to preventative care through remote doctor’s appointments will go a long way to improving overall health and cutting down on the need for medical emergencies.

Finally, we need more research. This is still a new area of study where the Maine research seems to be the only real insight. Getting a better understanding of how these ambulance deserts affect the greater population and commerce will go a long way to convincing lawmakers of what needs to be changed.

There are also unique ideas like filling in the gaps by allowing veterinarians to provide minor essential services or outfitting fire departments with more significant medical training. At this point, out-of-the-box ideas can go a long way to lowering the chances of your mother not getting the aid she needs after accidentally opening a box with a rattlesnake inside (yes, that does happen).

The point is we have a large rural community of hardworking mothers, fathers, brothers, and sisters, all with unique needs. We cannot predict where the next emergency will occur, but we can do all that is possible to lower the chances of those emergencies creating a cascading effect of poor medical help. With a little research, creative thinking, and determination, we can shift the current dialogue about ambulance deserts, so the rural community feels heard and served.

Written by: Emmanuel J. Osemota