Rural Emergency Medical Services

The Washington State Department of Health is committed to advancing the highest level of pre-hospital care across our communities. One way we strive toward this goal is by developing and expanding a statewide model aimed at strengthening the sustainability of rural EMS systems. This work focuses on increasing access to education, resources, and opportunities for collaboration. While the model emphasizes rural EMS services, the tools and resources developed are available to support and benefit all EMS services, providers and leaders across the state.  

Key Initiatives

  • Develop a statewide model for strengthening the sustainability of rural EMS systems. 
  • Create a repository of educational resources, reference materials, and operational templates designed to support system resilience.  
  • Encourage collaboration and promote awareness of EMS best practices.  
  • Improve access to leadership development and EMS education in rural communities. 
  • Improve access to national competency testing for volunteers who want to become certified as an EMR, EMT, AEMT, or Paramedic. 

Funding for key initiatives provided by the Medicare Rural Hospital Flexibility / Emergency Medical Services Programs (FLEX).

FLEX EMS Grant Awards and Outcomes

Participant Selection Criteria

Each grant cycle varies in topic, scope and timeline. Criteria for participation in each grant cycle varies, however, in general, criteria for enrollment into a grant cohort includes: 

Enrolled EMS Service Map 

Overall, 35 EMS services have participated in grant cohorts. These services have improved various components and attributes of their operations to strengthen their sustainability.

Picture of Enrolled EMS Service Map
2018-2019 Rural EMS Service Sustainability Assessment

Date: 2018-2019  

Enrolled EMS Services: No EMS services were enrolled. This grant supported the department in the development and deployment of a baseline survey to all EMS services across the states. Results were collated, analyzed, and a report was developed. The report was used to help determine where the department should focus efforts to strengthen EMS service sustainability. 

Objective: Developed and deployed an EMS survey based on the 18 Attributes of Success to all actively licensed EMS services in Washington to compile baseline data. 

Outcome: Over 80% of the 481 licensed EMS services completed this survey. The survey was analyzed and memorialized in a report. The department developed and made available a workbook that provides the best practices EMS services could adopt to help improve in each attribute area.  

2019-2022 Improving Attributes of Sustainability, Community Outreach, Recruitment and Retention, Data Reporting

Date: 2019-2022 

Award Amount: $750,000 

Enrolled EMS Services: 

  • Central Region 
    • Skykomish Fire Department/King County FPD#50 
  • East Region 
    • Spokane County Fire District #12
    • Stevens County Fire District #4
    • Wilbur Ambulance
  • North Region 
    • San Juan County FPD #5: Shaw Island EMS
  • North Central Region 
    • Lake Wenatchee Fire and Rescue 
    • Waterville Ambulance 
  • •    Northwest Region 
    • Clallam County Fire District 5 
  • South Central Region 
    • Franklin County FPD #3 
  • Southwest Region
    • Cathlamet Fire Department
    • Klickitat Rural 7 Fire & Rescue
  • West Region 
    • Lewis County Fire District 8 

Objective: Using the results from the 2019 Rural EMS Services Survey Results Report, create educational resources, reference materials, and operational templates designed to support system resilience and sustainability focused on the following attributes:

  • Involvement in the community
  • A community based and representative board
  • A recruitment and retention plan
  • Public information, education and relations (PIER)
  • Data reporting to the statewide EMS data registry (WEMSIS)

Outcome: The enrolled EMS services improved in all attribute areas. The largest improvements were in public information, education and relations, and contemporary equipment and technology. Seven (7) of the 12 participating EMS services were already reporting to WEMSIS when they began the grant work. Four more services started reporting during the grant work. The number of records submitted in 2021 increased by over 500, or by 38%, from the year before the grant started. New services were most of the new reporting, though prior reporting services have started reporting more records to WEMSIS. Enrolled EMS services increased the number of EMS personnel recruited into their services collectively by 27 and 14 EMS providers became EMS instructors.

2022-2024 Improving Attributes of Sustainability - Quality Improvement Programs

Date: 2022-2024

Award Amount: $600,000

Enrolled EMS Services: 

  • Central Region 
    • Snoqualmie Pass Fire & Rescue 
  • East Region 
    • Pend Oreille County Fire District #4
  • North Region 
    • Snohomish County Fire District #5
  • North Central Region 
    • Grant County Fire Protection District #8
  • Northwest Region 
    • Clallam County Public Hospital District #1
  • South Central Region 
    • Franklin County Public Hospital District # 1, 
  • Southwest Region
    • Pacific County Fire District# 1    
  • West Region 
    • South Thurston Fire & EMS

Objective: Introduce the concept of service level quality improvement projects, provide training on the methods and processes for implementation. The three EMS performance measures or key performance indicators (KPIs), chosen included critical trauma patient management, ACS/chest pain patient management, and stroke/TIA patient management.

Critical trauma patient management: 

  • Metric 1.2 - Percent of Step 1 and Step 2 trauma patients transported to a designated trauma center increase to 100%.

 
ACS/chest pain patient management:

  • Metric 5.1 - Percent of patients 35 years old or older with suspected cardiac chest pain, discomfort, or other ACS symptoms who received aspirin (ASA) from EMS or had the aspirin protocol documented increase to 100%.

Stroke/TIA patient management: 

  • Metric 6.1 - Percent of suspected CVA/TIA patients with a FAST exam (i.e. neuro screening) performed and all elements documented or documentation of why an exam could not be completed increase to 100%.

Outcome: 

Critical trauma patient management:

  • Metric 1.2 – Baseline of 76%, increased to 86% at the end of year one, and increased to 100% at the project conclusion.

ACS/chest pain patient management:

  • Metric 5.1 – Baseline of 57%, increased to 65% at the end of year one, and increased to 78% at the project conclusion.

Stroke/TIA patient management:

  • Metric 6.1 - Baseline of 63%, increased to 81% at the end of year one, and increased to 94% at the project conclusion.
2024-2029 Improving Attributes of Sustainability -Measuring Workforce Capacity, Recruitment and Retention and Reimbursement Management

Date: 2024-2029 

Award Amount: $1,250,000 

Enrolled EMS Services:  

  • Central Region
    • King County Fire District 27 
  • East Region  
    • Othello Ambulance Service 
    • Stevens County Fire District #5  
  • North Region  
    • Lopez Fire and EMS 
  • North Central Region  
    • Grant County Fire Protection District #8 
  • Northwest Region  
    • Mason County Fire District #13 
    • Quilcene Fire Rescue 
  • South Central Region  
    • Franklin County Fire District #3  
    • Kittitas County Fire District #1 
  • Southwest Region 
    • Cathlamet Fire Department  
    • Cowlitz-Skamania Fire District #7     
  • West Region  
    • Lewis County Fire District #4 

Objective: Assess statewide EMS workforce capacity, gather baseline data from enrolled services, research and develop recruitment and retention strategies, assess and improve reimbursement and billing management skills. 

Outcome: Will be updated as the project progresses and data is collected and analyzed. 

The 18 EMS Attributes of Success

Where do the 18 EMS Attributes of Success come from? 

In 2015, a national group of EMS providers and advocates worked to develop an assessment to compare EMS capacity statewide, and nationally. States could use the assessment to get a better sense of EMS strengths and needs, target funding and support to address gaps. The assessment identifies eighteen attributes that provide a foundation for success within rural EMS services. There are five groups of attributes, operations, finance, quality, public relations, and human resources, and several sub attributes within each group.

What are the 18 EMS Attributes of Success? 

Operations 

1. A Written Call Schedule  

2. Continuing Education 

3. A Written Policy and Procedure Manual 

4. Incident Response and Mental Wellness 

Finance 

5. A Sustainable Budget 

6. A Professional Billing Process 

Quality 

7. County Medical Program Director Involvement 

8. A Quality Improvement/Assurance Process 

9. Contemporary Equipment and Technology for Patient Care Reporting Activities 

10. The EMS Service Reports Data 

Public Relations 

11. A Community-Based and Representative Board 

12. EMS Service Attire 

13. Public Information, Education, and Relations (PIER) 

14. Involvement in the Community 

Human Resources 

15. A Recruitment and Retention Plan 

16. Formal Personnel Standards 

17. An Identified EMS Operations Leader with a Succession Plan 

18. A Wellness Program for EMS Service Staff 

In 2018, the department deployed this assessment to all EMS services in Washington State. 

The assessment provided comprehensive results that were mappable, comparable and specific. The method provided some quantitative results and allowed the department a qualitative description of what rural EMS services needed the most.  

In addition to assessing capacity, the department adopted a workbook based on the original model that provided a description of how to improve as a free resource to small/rural EMS services. 

This workbook is designed for use by EMS services:  

  • Regardless of service level, roster size, call volume, geographic location or response area.  
  • Interested in improving performance in one or more of the attributes. 
  • Looking to make either large multi-level improvements or small incremental improvements. These improvements are referred to as steps in the workbook. 

If your EMS service would like a guided assessment, please contact us to schedule a time. 

Education, Reference Materials, Operational Templates

The department has created a repository of educational resources, reference materials, and operational templates designed to support system resilience. To request access to the repository, please email us.  

Educational topics include: 

  • EMS Mental Wellness course 
  • Leadership course 
  • EMS Instructor Methodology course 
  • 18 attributes topics – presentations and supplemental materials  

Additional Resources: 

Opportunities to Engage

Rural EMS Learning Action Network (LAN)

Interested parties can engage in this work and learn more by attending the monthly cohort meetings scheduled on the third Thursday of each month from 10:00AM – 1:00PM.  

Meeting agenda includes an educational presentation from a subject matter expert and updates from participating EMS services in the cohort. To be added to the notification list for these meetings sign up on GovDelivery if you already are a GovDelivery subscriber scroll down to the Emergency Medical Services and Trauma section to find Rural EMS Workforce Project.

Contact for more information and Assistance 

For more information, please contact us.