An underlying theme of the discussion was that for a service to be able to step up in the face of an MCI or other disaster, it must first be able to provide adequate care on a daily basis for routine emergency calls and transports. Some participants also emphasized the importance of planning.

Another model discussed was a county-supported, tax-supported rural EMS agency that pays EMTs for responding to calls. It was suggested that pay varies according to certification and whether the responder was on call or at the station, or responded from home.

Participants raised concerns about the general fragility of the current rural EMS infrastructure. Many rural EMS agencies struggle to meet the basic community needs. Collapse of one component of the prehospital system, suggested workshop chair Robert Bass, will affect others in the community, such as the local rural hospital, and will place more stress on neighboring agencies. Limited resources as well as limited coordination between and within jurisdictions limits a prehospital system’s capacity to respond. As described previously in the chapter, several participants suggested that improved collaboration and alignment of resources will strengthen rural EMS.

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