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Rural hospital closures strain ambulance services

par John R. Fischer, Senior Reporter | June 02, 2021
Emergency Medicine
Rural hospital closures have led to overcapacity and longer travel distances for EMS ambulance services
Rural hospital closures are straining emergency medical service (EMS) providers to the max as they struggle to transport patients long distances to hospitals in as little time as possible.

That’s what researchers at the University of Minnesota School of Public Health found in a new study, which recorded longer travel distances for specialized or emergency care following the shut down of hospitals in rural areas. “When hospitals close, municipal EMS agencies are forced to adjust, often hampered by tight budgets, limited personnel and other constraints. As for private companies, they have the option to walk away when the current contract expires if they feel it’s no longer worth it,” said lead author and associate professor Sayeh Nikpay in a statement.

Nikpay and her team evaluated locations of recent rural hospital closings and EMS providers in those areas. They used Medicare payment data to calculate the number of trips made, their distance and whether they were emergency, interfacility or medical appointment transport.

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Average length of ambulance trips for municipal EMS agencies rose 22% following closures. The average length of ambulance trips for private EMS agencies went up 10% in these areas and interfacility transfers and non-emergency EMS trips fell by 31% for all agencies. Total number of trips remained the same, due likely to agencies already operating at full capacity and prioritizing emergency calls over transfers and non-emergency transport.

Closures, according to the researchers, pressure public EMS agencies in rural communities and causes equipment to undergo more wear and tear, creates more “dead time” spent returning to the ambulance base and leads to employee overtime and burnout. It also does not allow for as much time to restock and maintain vehicles and causes providers to cut back on routine medical appointment runs, instead relying primarily on emergency transportation as a main revenue stream.

Nikpay says this causes delays or denials in care for people in need of transport. She encourages policymakers to increase funding for additional equipment, vehicles, facilities and personnel to support rural EMS agencies when hospitals close.

The findings were published in Academic Emergency Medicine.

Nikpay did not respond for comment.

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