Survey of local ems directors in rural and urban areas finds rural agencies were more likely to 5 be staffed by volunteers only 53 for isolated small rural vs 14 for urban see figure 3 31 . Rural ems systems face unique challenges poorly defined geographical boundaries low population densities and call volumes elongated response and transport times the need for more well . Negative impacts on rural areas of policies primarily designed for and responsive to the needs of urban areas however some rural areas continue to have high num. Highlights a guidebook designed to help rural emergency medical services ems and emergency response systems with development modification consolidation and collaboration discusses ems system upgrades administration funding and budgeting
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