Ambulance services across the U.S. are shutting down as rural response teams made up almost entirely of volunteers are unable to sustain services, putting about 60 million Americans at risk of losing access to care in a medical emergency, according to NBC News.
The demand for healthcare in rural areas is greater than the supply of people needed to provide the care, with only 19.3 percent of the 2010 U.S. population considered rural, a dramatic drop from 60 percent in 1900, according to the U.S. Census Bureau.
Since 2010, 118 rural hospitals across the U.S. have closed, though that number doesn't account for small facilities that temporarily shut down and then reopened. Many of the shuttered hospitals were in states that did not expand Medicaid under the Affordable Care Act, according to a University of North Carolina report cited by NBC News.
"We've never had this many hospitals close this fast in this country," Nikki King, a National Rural Health Association member, told NBC News.
Younger, healthier individuals often move from rural areas to big cities, depleting available emergency personnel volunteers and leaving behind aging, often low-income adults more likely to need emergency medical services.
"Seventy percent to 74 percent of the emergency medical services are provided by people for whom that is not their full-time job," Andy Gienapp, head of the office of emergency medical services for Wyoming's health department, told NBC News.
EMS volunteers typically don't receive benefits, but the work still requires training that costs hundreds of dollars. Fewer rural hospitals means ambulances have longer drives and fewer calls can be answered, resulting in less money. Funding can come from state legislatures but it generally doesn't because most states don't consider local emergency medical services "essential."
Mr. Gienapp and other experts believe a system reliant on community volunteers is simply not sustainable.