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Volume 15: A Guide for Enhancing Rural Emergency Medical Services

Improved EMS Delivery Can Reduce Fatalities on Rural Roads

The Problem About 80 percent of the nation’s roads are in rural areas, but they account for only 40 percent of vehicle miles traveled and only 21 percent of people live in rural areas. So it may surprise some people that a disproportionate number of severe crashes and 58 percent of all traffic fatalities occur in rural areas. In 2004 crashes in rural areas claimed 24,975 lives.

These crashes present special challenges for Emergency Medical Services providers. Response times are typically longer, and many EMS tasks fall on volunteers, who provide up to three-quarters of the EMS services in rural areas. Volunteers often lack adequate financial resources, must use aging or inadequate equipment, lack training opportunities close to home, and have difficulty in maintaining skills due to low call volumes. Many operate in areas with gaps in telecommunications, lack proper medical direction, must perform in the absence of local medical facilities, and do not have access to regionalized systems of specialized EMS care.

Absent adequate funds and resources, system managers need to look at alternative solutions to achieve improved outcomes. This guide focuses on achievable alternatives, focusing on two fundamental issues: minimizing response times for personnel and equipment to treat crash victims, and improving the medical care afforded victims.


  • Integrate services to enhance EMS capabilities.
  • Provide and/or improve management and decision-making tools.
  • Provide better education opportunities for rural EMS.
  • Reduce time from injury to appropriate definitive care.

Download this guide: http://trb.org/publications/nchrp/nchrp_rpt_500v15.pdf

NCHRP 500-15

Rural EMS

This guide focuses on these fundamental issues: minimizing response times for personnel, adequate equipment to treat crash victims, and improving the medical care afforded victims.

Download the guide in PDF

View the Guide and Appendices in HTML

Order a printed copy

Related publications

Enhancing Rural EMS One-Pager

Self Assessment Tool

Integrated Safety Management Process