To ensure access to emergency medical services (EMS) for all rural residents, state legislatures should designate EMS as an essential service and provide a portion of the funding necessary to support the costs of maintaining essential service designations. State EMS advocacy organizations should promote, and support with educational grants, professional EMS management certification for rural and low-volume ambulance agency directors. State-based EMS regulatory boards, supported by applicable federal agencies and programs, should create (or modify existing) EMS zones to comprehensively include rural areas and accelerate reliable EMS coordination within geographically defined EMS zones. State legislatures should preferentially direct ambulance agency funding to cover ambulance agency standby costs and support EMS coordination within geographically defined EMS zones that include all rural parts of the state.
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