The steep rise in rural hospital closures over the past decade is hurting many emergency medical service providers, worrying public experts tracking response times.
The average length of ambulance trips increased by 22% among municipally-run, EMS agencies and 10% among privately-owned providers between 2012 and 2018 in locations where a recent rural hospital closure took place, according to a new study from the University of Minnesota School of Public Health.
The actual number of trips those providers made did not change during the study period. But the analysis found rural EMS providers decreased their number of non-emergency and inter-facility transfer trips by 31%. Lead study author Sayeh Nikpay, associate professor in the division of health policy and management at the University of Minnesota School of Public Health, said the drop in planned trips made it harder for EMS providers to dispatch ambulances in a way that ensured communities had adequate coverage.
"Taking someone from the community to a hospital-based clinic is more predictable and has the benefit of bringing people in the community access to their primary care," Nikpay said.
Nikpay said the burden of hospital closures is particularly acute among municipal EMS providers. While private firms have the option to discontinue providing ambulance services when it no longer is financially viable, municipal agencies are forced to adjust, which Nikpay said often leads to limited resources and personnel that can affect the quality of those services.
"It's difficult for EMS agencies to retain people, to recruit new people, and the people that are there feel a lot of strain," Nikpay said.
Researchers said the problems facing rural public EMS agencies is a growing public health concern. It's putting more wear and tear on their equipment and increasing the "dead time" being spent traveling back to ambulance bases. EMS providers also have less time to restock and maintain vehicles.
Nikpay said the strain on rural EMS providers has only been exacerbated by the pandemic.
Last year, 19 rural hospitals closed, according to figures from the Cecil G. Sheps Center for Health Services Research at the University of North Carolina-Chapel Hill, the highest number for a single year since the center began tracking. Overall, 180 rural hospitals have closed since 2005, with more than three-fourths occurring since 2010.
Nikpay said the study's findings suggest policymakers need to also look at ways of supporting EMS providers when addressing issues related to bolstering the country's rural healthcare system.
"We shouldn't just be thinking about the hospitals when we talk about rural healthcare, we should also think about the EMS agencies as well," Nikpay said.