Challenges Facing Michigan's Rural EMS Agencies 

The challenges posed to Michigan’s rural emergency medical service (EMS) agencies aren’t necessarily unique, but they are current and immediate.

EMS agencies – both rural and urban – throughout Michigan are facing common hardships in many of the same discussion points, but what exacerbates them in rural environments are the geography, population volumes, and the overall access to care for its citizens. Each of these factors affects the EMS system, agency recruitment efforts, and provider retention initiatives within Michigan’s rural EMS agencies in ways that urban areas can relate to, but not directly compare.

Even nationally, the same challenges faced by Michigan’s rural EMS agencies are often replicated across many other states’ borders. While these challenges are gaining the recent spotlight in newsreels and social media efforts, much of the weight of the collective voice of the EMS industry is muffled because it is not legislatively recognized as an “essential service,” compared to its law enforcement and fire service counterparts.

Nevertheless, efforts by professional associations, stakeholder groups, EMS agencies, and EMS providers themselves have been underway to help bring the many challenges facing rural EMS providers and agencies throughout the state to the forefront, but not always to any avail. Outlined in this evaluation is a high-level overview of a few of the primary challenges facing Michigan’s rural EMS system as a whole.


  • There are over 28,000 licensed EMS providers in Michigan that support nearly 800 individual EMS agencies spread throughout various urban and rural communities.
  • Less than a dozen states have legislation considering EMS as an “essential service,” affording it tax-supported status; Michigan is not one of them.
  • With regards to Medicare & Medicaid reimbursement, it is a genesis belief that EMS agencies do not provide reimbursable patient care to patients; rather, they only provide reimbursable transportation services to patients.
  • Michigan’s large geography, limited access to public transportation, long travel times to health care, and its general infrastructure status & road conditions are all main barriers to rural health care.
  • 91% of managers identified recruitment of new personnel or volunteers as a major or moderate challenge facing Michigan’s rural fire/EMS agencies.
  • Initial EMT (emergency medical technician) training can take between 160-200 hours, while initial paramedic training typically involves a full-time, two-semester commitment at a local community/technical college.
  • 39% of respondents to a 2020 national EMS survey did not recommend their children enter into the EMS workforce (compared to 12% not recommending EMS in 2018).
  • Nationally, EMS providers face a burnout rate of 37%.
  • 65% of Michigan’s rural fire/EMS providers reported experiencing critical stress throughout their tenure and 14% had thought about suicide.
EMSCC Rural Subcommittee FINAL.Abstract of Challenges 002.pdf (