in setting national policy for EMS. Instead there is a patchwork of available resources, commented Bass, that do not meet the complete needs of the health care sector due to an absence of directed federal guidance and policy. This absence of a specific federal advocate results in an inability of EMS, at both the federal and state level, to attain the same priority as other components of the health system in terms of having the necessary guidance and resources to prepare for and respond to an MCI. In addition, although EMS is a critical component of the emergency response system other first responder communities, such as police and fire, receive a significantly larger portion of federal grant dollars compared to EMS. This was highlighted in 2007 congressional testimony by the Department of Homeland Security to the House Appropriations Committee: less than 4 percent of DHS grants to state and local agencies is directed towards EMS functions (DHS to Committees on Appropriations, 2007).

Granting agencies such as the DHS, ASPR, NHTSA, the Health Resources and Services Administration (HRSA), the Federal Emergency Management Agency (FEMA), and others need to review their grant guidance and how funding is directed and distributed to ensure appropriate resources are provided to EMS and for rural MCI planning. Strong federal direction of this kind can help ensure EMS is a fully integrated component of the emergency response system. This could have the affect of stabilizing EMS funding within federal and state budgets so that it is less vulnerable to economic stability trends (receiving more funding in “boom” years, and seeing that funding drastically cut during recessions). To this end it is important to similarly include public and private healthcare insurers in discussions of sustained funding. Specific suggestions for integrating the funding provided by the Medicare and Medicaid payer, the Centers for Medicare and Medicaid Services (CMS), are discussed below.

When engaging an entity on the issue of funding, noted associate chief medical officer at the Office of Health Affairs at DHS Mike Zanker, emphasis should not only be given to urban centers. In addition to the need for rural EMS to respond to an MCI in their community, in the event of a major urban incident urban communities will be reliant on their rural neighbors to help support response efforts, especially if the urban center is incapacitated.

Eileen Holloran, a public health analyst in the Office of Rural Health Policy at HRSA described four current grant programs that support im-