Hour-Long Emergencies: The Struggles of Rural EMS

Authored By: Louis Rivera

Emergency Medical Responders serve as our frontline in the prehospital chain of survival and are part of the core three emergency units we often see passing by our houses: police, fire, and EMS. EMS workers across America responded to approximately 60 million calls in 2024, averaging around 165,000 calls per day [1]. Despite this, they are not considered an “essential” service by law. The New York State Senate has passed a bill, Senate Bill S7501, that classified EMS workers as “essential” during the summer of 2025 [2], which now requires all counties, cities, towns, and villages in NYS to outline funding plans for their local EMS agencies. Given this, and my perspective as a certified emergency medical technician in New York State, I offer a unique perspective on the overlooked struggles in rural upstate New York and advocate for continued advancements, funding, training, and resources to be allocated to the nation's emergency backbone. 

There are four core EMS practicing levels: EMT-Basic, EMT-Advanced, Critical Care Technician, and Paramedic, each of which, with increasing level, can complete more advanced procedures and therapies. The first key issue is that one may assume there would be considerable growth in pay per level, especially for paramedics who undergo over a year of training and are assigned to the most complex and dangerous prehospital cases. This is not entirely true, as both urban and local environments pay EMS workers extremely low salaries, typically around minimum wage for the lowest levels [3]. With a shortage of compensated training opportunities, it makes little sense for these workers to relocate to rural agencies, where agencies often face worse funding than in larger municipalities [4]. Local agencies are then tasked with finding certified paramedics or investing in a two to three-year timeline that involves training an EMT, having them work for a while, and then sponsoring their paramedic class for a year. Given this complex nature of acquiring paramedics (the most in-demand class of EMS workers), many rural EMS agencies are left without paramedics or only part-time paramedic coverage [5], leaving vast areas of coverage without providers that could be the difference between life and death, and without adequate funding towards personnel, especially in local agencies, there will continue to be to be a deficit of all levels of providers, especially paramedics, in rural upstate America which has and will continue to be the difference between many individuals livelihood. 

A core component of these issues is also the rising cost of “fuel, supplies, and the cost of readiness,” says Curtis Hammond from the upstate agencies in Candor, NY, Candor EMS, and the EMS Sustainability Alliance [6]. While prices increase for supplies and fuel, there is a barely noticeable rise in funding [4], which could change with the continued implementation of Senate Bill S7501 in New York State [2]. However, funding remains suboptimal and is much worse in other states. These prices are further exacerbated by inflation and decreased federal funding for Medicaid and rural hospitals [7], resulting in a lower rate of reimbursement for a large population that relies on EMS work, as well as higher costs associated with longer transport times, including fuel, medication/treatments, and time allocated. Spending cuts are sometimes passed on to EMS workers to keep agencies afloat, further exacerbating the staffing issue mentioned previously. All of these issues plague agencies across America, and while introducing statewide reforms in New York has made improvements, there is still much to be done on the implementation side of the bill, as well as similar priorities in the 29 states that do not yet designate EMS as an essential service [8]. 

What can one do to improve these issues in their state? A significant part involves advocacy to local, state, and national governments. The passage of bills like Senate Bill S7501 has shown drastic improvements in New York State agencies. Advocating for other states to establish similar legislated requirements for municipalities would also enhance EMS work in various areas. While bills like Senate Bill S7501 require municipalities to provide funding plans, state and federal funding would hopefully be the end goal of a near-perfect EMS funding program. Advocating for this and being informed about how issues affect our community is essential in this aspect. In local terms, support EMS events, figure out how to get involved, or simply appreciate the EMS workers who work day in and out to provide service despite low pay, long hours, and the challenges of keeping our friends and families alive. 

Works Cited

1. Choffman. (2025, June 17). 2024 NEMSIS Public-Release Research Dataset Now Available. NEMSIS. https://nemsis.org/2024-nemsis-public-release-research-dataset-now-available/

2. NY State Senate Bill 2025-S7501. (n.d.). Retrieved October 13, 2025, from https://www.nysenate.gov/legislation/bills/2025/S7501/amendment/original

3.  Friese, G., MS, & NRP. (2021, July 7). Disrespect for NYC EMS is disrespect for EMS everywhere. EMS1. https://www.ems1.com/labor-issues/articles/disrespect-for-nyc-ems-is-disrespect-for-ems-everywhere-peYNZ0jEkKPu77bJ/

4. King, N., Pigman, M., EMS Services in Rural America: Challenges and Opportunities. (2019) National Rural Health Association https://www.ruralhealth.us/getmedia/cc0078fa-14d2-47eb-98a6-2bb6722e540c/2019-NRHA-Policy-Document-EMS-Services-in-Rural-America-Challenges-and-Opportunities.pdf

5. Listing of Ambulance and Advanced Life Support First Response Services in New York. (2025, August 18). New York State Department of Health. https://www.health.ny.gov/professionals/ems/pdf/agency_list_aalffrs.pdf

6. Curren, D. (2025, June 19). EMS services set to be recognized as essential in NYS. Https://Www.Wbng.Com. https://www.wbng.com/2025/06/19/ems-services-set-be-recognized-essential-nys/

7. Wirth, S., Zavadsky, M., MS-HSA, EMT, & Group, P. A. (2025, July 22). The ‘One Big Beautiful Bill Act’: What EMS leaders must know now. EMS1. https://www.ems1.com/legislation-funding/the-one-big-beautiful-bill-act-what-ems-leaders-must-know-now

8. State Policies Defining EMS as Essential. (n.d.). Retrieved October 13, 2025, from https://www.ncsl.org/health/state-policies-defining-ems-as-essential