Emergency medical services (EMS) are the most immediate health care resource for many US residents living in rural areas. We all rely on EMS to coordinate deployment of networks of transporters, first-responders, basic and intermediate emergency medical technicians, paramedics, and medical directors. These clinicians bring professional skill sets and scopes of practice to their crews when our health needs are urgent. Yet, low call volume in rural areas hinders responders’ exposure to real-life procedures and undermines reimbursement for services rendered, so many rural EMS programs must depend—and perhaps overly rely—on volunteers. Air transport and telehealth help some rural US residents overcome some proximity demands but are imperfect workarounds for meeting critical vulnerabilities and do not substantially mitigate rural/urban emergent care access inequity. This theme issue explores rural EMS as a source of clinical, legal, and policy-level questions neglected in health care ethics, policy, and equity discussions.

Background image by Sara Gironi Carnevale.