How Hospital Reimbursement Rules Brought ALS to Rural Nebraska

Before CAH designation, the ambulance service run by the 20-bed Nemaha County Hospital in Auburn, Nebraska, was typical of many rural EMS operations: It relied on volunteer EMTs to staff its ambulances. With only 120 to 140 transports a year, its EMTs struggled to maintain their skills. Tougher education requirements demanded more time to maintain certification; yet, even if volunteers could find more time, employers were increasingly unhappy about paying employees who were gone from their jobs for hours or even an entire day transporting patients close to 140 miles round-trip to hospitals in Omaha and Lincoln.

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