Rural EMS


The provision of emergency medical services in the rural environment poses many challenges. The remoteness and inaccessibility of some rural and wilderness areas significantly reduces the capacity of EMS agencies to respond to a patient in need. Other challenges include poor provider reimbursement, recruitment and retention difficulties, a dwindling pool of volunteer personnel, aging infrastructure, communication technology problems, lack of access to qualified medical direction, and continuing education. NASEMSO recognizes the need for a continued focus on the needs facing the EMS systems in rural and frontier areas.

Meeting schedule

The NASEMSO Rural Committee meets in person at the NASEMSO Annual Meeting. In between Annual Meetings, it meets as a part of the Joint Committee on Rural Emergency Care (JCREC) every month by conference call on the second Monday at 3 PM Eastern.  Its work plan is that of the JCREC.

Template for Emergency Medical Services Informed Community Self Determination (ICSD)

Informed self-determination provides a process in which:

  • An objective evaluation of the service is completed by an outside expert or entity using a standardized evaluation tool.
  • The evaluator reports on issues which jeopardize service performance and their impact on response and the and level of care provided.
  • Options are presented within accepted national practices and state EMS law and regulations, and their implementation and cost impacts explained.
  • The community holds a meeting(s) of taxpayers and/or their representative decision-makers, selects a level and type of service it desires, and establishes a level of funding needed to implement and sustain it.

The ICSD process is intended for EMS response areas that are rural, relatively isolated, and do not have multiple EMS resource options.

Rural Community Ambulance Agency Transformation consists of a self-assessment and associated resource collections in the areas of the Critical Access Hospital Blueprint for Performance Excellence, adapted specifically for rural ambulance agencies, from the Baldrige Excellence Framework for Health Care. Leaders are encouraged to complete the assessment periodically to monitor their progress and receive updated resources to guide their continued journey. The self-assessment and resource collections Include:

Legal Recognition of EMTs on Wildland Fires

This guide is intended to be used as reference material only. State policies are subject to change and may not be immediately reflected in this document. The processes listed below are for Basic Life Support only. Medical Unit Leaders, Logistic Section Chiefs, Agency Administrators, and others must appropriately research processes in each state.

Western States Processes for Legal Recognition of EMTs on Wildland Fires



Andy Gienapp, MS, NRP
State EMS Director
Wyoming Department of Health

For More Information

Kevin McGinnis, MPS, Paramedic Chief (Ret)
NASEMSO Program Manager