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, 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 varies in topic, scope and timeline. Criteria for participation in each grant may also vary. 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 our 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: 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.