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By HEATHER CHAPMAN
The Rural Blog

“The ambulance crews that service much of rural America have run out of money and volunteers, a crisis exacerbated by the demands of the pandemic and a neglected, patchwork 911 system. The problem transcends geography: In rural, upstate New York, crews are struggling to pay bills. In Wisconsin, older volunteers are retiring, and no one is taking their place,” Ali Watkins reports for The New York Times. “Many of the disappearing ambulances are staffed by volunteers, and some are for-profit ambulance providers that say they are losing money. Still, others are local contractors hired by municipalities that, strained by the budget crisis of the pandemic, can no longer afford to pay them.”

The story focuses on Wyoming, where the situation is particularly bad. “Nearly half of the population lives in territory so empty it is still considered the frontier. At least 10 localities in the state are in danger of losing ambulance service, some imminently, according to an analysis reviewed by The New York Times,” Watkins reports.

One independent rural ambulance provider is losing its contract with the county in June because of pandemic budget cuts. The owner suggested transitioning the private company to a public, tax-supported service funded by the county, but the county didn’t have the money, Watkins reports. So after June 30, the regional hospital nearby will have to respond on its own to emergency calls.

Another rural Wyoming ambulance service, bought out by national for-profit company American Medical Response in 2016, is shuttering because AMR says it’s no longer profitable to stay in rural Wyoming without government subsidies, Watkins reports. The low call volumes meant there wasn’t enough revenue to support the company, a spokesperson said.

The pandemic only hastened the current crisis in rural ambulance services, but low or sporadic call volumes are a big part of the problem, say experts who have warned for years that unreliable revenue streams endanger the nation’s emergency medical services.

“Critical to an ambulance’s survival is its ability to transport patients to hospitals, which allows it to bill for a transport,” Watkins reports. “That limited revenue stream dried up during the pandemic, according to workers across the country, when crews were discouraged from transporting all but the sickest of patients.” Instead, crews were told to provide care on scene, for which they are not paid.

“At the same time, many of the standard sorts of medical emergencies that helped keep ambulances afloat disappeared, either because people were moving around less, or were fearful of going to a hospital and exposing themselves to the coronavirus,” Watkins reports. “In dense urban areas like New York or Los Angeles, there are enough people and everyday maladies that an ambulance service can come closer to sustaining itself, and enough of a tax base that cities can support it. But in places like Wyoming, the least populous state and one notoriously averse to tax increases, each missed transport in 2020 was critically lost revenue.”

Adding to the problem, many states don’t consider ambulances essential services, and only a few states require local governments to provide them.

“For most of the country, access to an ambulance is a lottery. Some municipalities provide them as a public service, funded by taxpayers, while some contract with for-profit ambulance companies. Most rely on the willingness of volunteer companies,” Watkins reports. “But across the country, E.M.S. professionals say fewer and fewer people are willing to volunteer for the job, a phenomenon accelerated by the stress of the pandemic. Many municipalities expect volunteers to take time away from work, something few people can now afford to do.”

Heather Chapman writes for The Rural Blog, a service of the Institute for Rural Journalism and Community Issues at the University of Kentucky.