OBBB Impact on Rural Emergency Medical Services (EMS)

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by Will Anderson

Recent data shows that over 66 million people in the United States live in rural areas. ¹ Those living in these parts of the country typically have less access to healthcare and physicians compared to their urban counterparts. In 2022, there were nearly three times as many active physicians in the United States per 100,000 population in urban areas than in rural areas (286 vs. 98 per 100,000 population, respectively). ² The One Big Beautiful Bill (OBBB) is attempting to address these disparities to improve health measures and outcomes for those living in rural settings.


The rural hospital provisions in the OBBB, specifically Section 111201 on expanding the definition of rural emergency hospitals, have indirect but promising implications for EMS, fire, and law enforcement agencies that operate in rural areas. Here are three key impacts:



1. More Local Receiving Facilities = Shorter Transport Times

By allowing previously closed or reclassified rural hospitals to reopen as emergency hospitals, the OBBB could reduce how far first responders must transport patients.

• Many rural EMS agencies must travel >30 minutes to reach the nearest hospital.
• Reopening rural emergency hospitals creates closer stabilization and transfer points, which:
  
  
  • Reduces unit “out of service” time;
  • improves EMS system coverage and response capacity;
  • decreases patient handoff delays, especially in trauma, cardiac, and stroke events; and
  • may permit better response from volunteers since they know transport times and in-service times will improve.

Practical impacts: Rural fire/EMS units can return to service faster, improving coverage for the next call. Also, the faster turnaround times may produce a better response from volunteer fire and EMS personnel.



2. Strengthened Emergency Care Infrastructure

The bill ties facility eligibility to providing emergency services, not just routine care. Facilities must show that more than 50% of their services are emergency related. ³

• This aligns hospital operations with EMS response patterns.
• It supports better coordination between prehospital and in-hospital care, which may include:
  
  
  • Faster triage,
  • more appropriate patient routing, and
  • easier interfacility transfers.

Practical impact: First responders have more reliable destination options designed to handle emergency patients, rather than being forced to bypass under-equipped rural clinics.



3. Improved Surge & Disaster Readiness

Rural emergency hospitals are expected to meet federal service requirements and maintain EMS coordination capacity. This can:

• Enhance disaster response (e.g., MCI, severe weather, hazmat),
• provide stabilization capacity during large-scale incidents, and
• reduce the burden on regional trauma centers during surge events.

Practical impact: First responders get a stronger partner for mass-casualty or high-demand scenarios.

With the OBBB, we can expect federal grant funding for rural emergency services to expand as funds are provided to each state. State agencies will, in turn, award funds to local municipalities. Those responsible for grants and grants management in rural areas can take three steps to prepare their agency for these upcoming opportunities:

• Ensure the System for Award Management (SAM) registration is active. Visit www.sam.gov to verify your agency can access federal grant funding.
• Complete a needs assessment for your organization. What will need to be upgraded or added to your EMS inventory over the next three to five years?
• Establish or strengthen partnerships with community and regional stakeholders. Grant applications for regional projects are often favored over single-agency applications.
• Partner with Lexipol to assist with grant services. Services include grant research, reviews, consultations, and writing. Lexipol has access to over 14,000 grant programs from federal, state, foundation, and corporate grantmaking programs.

Fire & EMS Benefits of Rural Healthcare in OBBB

Area	Before Bill	After Bill Implementation
Transport times	Long, resource-draining	Shorter, faster unit turnaround
Hospital relationships	Often limited or distant	Closer integration and coordination
Incident command & disaster ops	Limited nearby stabilization capacity	More local receiving points and surge support
Leadership role	Reactive to hospital closures	Proactive seat at the planning table
Operational tempo	Fatigue, long transports	More flexible, better coverage
Opportunities	Limited	New grants, expanded services, better interoperability