Lack of medical coverage in rural America is a growing crisis that affects millions of people across the state and thousands in this county. While urban residents often live within minutes of hospitals, rural communities face shrinking healthcare infrastructure, long travel distances, provider shortages, and increasingly fragile emergency medical services.
Among the most urgent concerns is ambulance coverage, which in many rural areas is underfunded, understaffed, and stretched beyond sustainable limits.
Rural hospital closures have accelerated over the past two decades. Financial pressures, declining populations, lower reimbursement rates from Medicare and Medicaid, and high levels of uninsured patients have forced many facilities to shut down. When a rural hospital closes, the consequences ripple outward. Residents must travel farther for routine care, preventive services decline, and chronic conditions often go unmanaged.
Moreover, rural counties often lack primary care physicians, mental health providers, and specialists due to lower pay. As a result, patients delay seeking care, rely heavily on emergency rooms, or simply go without treatment. Preventable conditions such as diabetes, hypertension, and heart disease become more severe, increasing the likelihood of emergency situations that require rapid response.
In rural communities, ambulance call volumes are relatively low, and transport distances are long. Our units may be tied up for hours on a single call due to travel time to distant hospitals. This means fewer ambulances are available to respond to other emergencies.
In addition, rural ambulance services depend heavily on volunteers. However, volunteer EMTs often balance emergency responses with full-time jobs and family responsibilities. As rural populations age and younger residents move away, volunteer recruitment becomes increasingly difficult. Some communities struggle to maintain minimum staffing levels, leading to delayed response times that can mean the difference between life and death.
The consequences of inadequate medical and ambulance coverage are profound. Rural residents experience higher rates of preventable deaths and maternal mortality. Delayed emergency responses worsen outcomes for heart attacks, strokes, farming accidents, and motor vehicle crashes—incidents that are more common in rural settings.
These issues are complicated and systemic, and addressing this crisis requires multifaceted solutions. After talking with several experts in this field (which I am not), I am passing on some suggestions for us to discuss with our elected officials.
1. Expand Funding and Reimbursement Reform
The state has recently dedicated funds to bolster EMS operations. There is a new $6 million investment in the EMS Operating Fund which supports recruitment, training, and equipment purchases through regional EMS councils. Expanding and making this type of funding more consistent year-to-year would help stabilize financially strained services.
A. Reimburse More Realistically for Responses
The state has recently passed laws that increase ambulance reimbursement rates, tying Medicaid payments to the higher federal rate and paying for all patient transport miles — an important step for rural providers who often travel long distances.
Further reimbursement reforms could include:
• Paying for non-transport care (treatment on scene), so services get revenue even when no hospital trip occurs.
• Creating a statewide fee schedule so insurers reimburse more predictably and sustainably.
• Expanding tele-health to improve access to specialists and reduce unnecessary transports.
• Reverting to a system that requires insurance payments go directly to the EMS agency instead of the patient.
• Increasing the pro-rated insurance payments. An EMS agency will bill based on their cost of a run but only receive pennies on the dollar for that invoice.
B. Expand Local Taxing Authority
Bills in the legislature would allow more municipalities to levy taxes specifically for fire and EMS funding. Instead of relying solely on reimbursements and donations, towns could generate dedicated local revenue to support staffing and operations.
2. Workforce Recruitment and Retention
A. Grow EMS Career Pipelines
Local governments and hospitals could partner with schools and community colleges to offer tuition assistance and stipends for training and create EMS certification programs that funnel graduates directly into local services. Greene County CTC is already doing this and has a very successful program assisting students to achieve their certification.
B. Better Pay and Benefits
Part of the staffing crisis stems from low wages and high stress; EMS personnel often make less than jobs requiring similar responsibility, contributing to burnout and turnover. Competitive pay, benefits, and loan forgiveness for service in rural areas could make EMS careers more attractive.
3. Shared Services
A. Create Regional EMS Authorities where multiple towns pool resources to fund, manage, and operate ambulance services collaboratively. This spreads costs and stabilizes coverage.
Regional authorities can:
• Coordinate staffing and equipment across municipalities.
• Set uniform fees or contributions.
• Provide consistent service levels that single small towns struggle to sustain.
According to Richie Policz, Director of Greene County Emergency Services, he has met with local municipal association members concerning these issues. They are researching opportunities to apply for grants to help offset the costs of EMS services.
B. County-Level EMS Coordination
Some officials and advocacy groups recommend shifting EMS oversight to counties rather than leaving it fragmented across many small municipalities. This can improve planning, budgeting, and service allocation. Although, this would require a rewrite of Pennsylvania Act 69 and Title 35.
4. Reduce Operational Barriers
A. Flexible Staffing Rules
Pennsylvania’s Act 17 allows exceptions to rigid ambulance staffing requirements in extraordinary circumstances, which can help struggling rural services remain operational rather than shut down for lack of personnel. Continued refinement of staffing regulations could reduce unnecessary barriers while maintaining safety.
B. Shared Services Among First Responders
Some fire departments operate Quick Response Services (QRS) or integrated EMS units that provide basic care and support for ambulance crews. Encouraging these tiered response structures — where trained first responders begin care while ambulances are en route — can improve response times and reduce strain.
According to Policz, Clarksville, Jefferson, Nemacolin, and Rices Landing already have EMS/ambulance service attached to the fire companies. New Freeport VFC has a Certified QRS.
Unfortunately, over the past 15 years, Greene County has lost four volunteer fire company- based EMS services
5. Look to New Technologies
Policz also discussed possible solutions on the horizon. “We have reviewed a new concept of using drones to deliver AEDs and certain medications to medical emergencies in areas that have a long ambulance response time. Pilot programs in other PA counties are showing positive results, but funding to launch these programs are the biggest hurdle to make it possible and continued support of the program.”
Ultimately, access to timely medical care is not simply a matter of convenience; it is a matter of equity and survival. Without meaningful investment and policy reform, rural communities risk further erosion of essential healthcare services, leaving residents increasingly vulnerable in moments when help is needed most.
