Most 911 Calls Aren’t for Police… They’re for FIRE / EMS And Rural America Already Knows It
Chances are, if you live in rural America, you know somebody in Fire / EMS.
If you don’t, you have probably met them the hard way. In your driveway. In your living room. Standing beside a family member on a day you will never forget.
That is just the way it is out here.
There is a common belief that 911 is mostly about law enforcement. Patrol cars. Crime scenes. Big city emergencies. But talk to any rural fire chief and they will tell you something different, and they will tell it to you straight.
Most 911 calls are medical.
Falls. Heart attacks. Breathing issues. Lift assists for elderly parents. Overdoses. Wellness checks. The everyday emergencies that never make the evening news but happen constantly across small towns, farms, and mountain communities.
In a recent Rural Route Review conversation, Fire Chief Robert Anderson Jr., a third generation professional firefighter who started as a volunteer fireman in 1986, explained how much the job has changed. When he first joined, departments were running outdated gear, older trucks, and very limited budgets. They were behind in technology and funding, but the pager still went off and folks still showed up.
They still do.
Only now the mission is much heavier. Emergency Medical Services drive the overwhelming majority of calls, and in many rural communities the fire department has effectively become the EMS system. Same station. Same crew. Same neighbors responding whether it is a fire, a medical emergency, or a call for help from an elderly resident living alone.
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What most people do not see is how the funding structure works behind the scenes.
Medicare and Medicaid rules do not explicitly say rural EMS should be reimbursed less. On paper, it appears neutral. But the reimbursement system is largely based on transport rather than readiness. Departments get paid when they transport a patient, not for being staffed, trained, equipped, and ready to respond across large geographic areas at all hours.
Unlike rural hospitals, EMS agencies do not receive cost based reimbursement. Payment formulas are volume driven, and rural departments naturally run fewer calls than urban systems while still carrying the same fixed costs for equipment, insurance, training, and staffing. Medicaid flexibility left to states and strict medical necessity transport rules can further limit reimbursement levels. Small rural payment add ons exist, but they are not nearly enough to offset longer distances, higher per call costs, and smaller rural tax bases.
So while the law may look fair, the real world outcome often is not.
Chief Anderson shared a practical example. A serious medical call can cost well over a thousand dollars in supplies, medications, fuel, and personnel time. Reimbursement may only cover a fraction of that cost. That gap does not disappear. It gets absorbed by local departments and the communities they serve.
Then you add rural hospital closures across rural America to the equation.
Now an ambulance may be gone an hour or more on a single transport across county lines. While that unit is tied up, the next 911 call is still coming from somewhere down a back road or up a holler. The emergency does not wait just because the system is stretched thin.
Travel across rural America and you hear the same story repeated. Staffing shortages. Declining volunteerism. Aging equipment. Funding models that do not match rural realities.
Yet when someone in a rural county dials 911, their expectation is simple. Help should come.
Most 911 calls in rural America are not about crime. They are about care.
And more often than not, that care is delivered by neighbors who answer the call, no matter the distance, no matter the hour, and no matter how tight the budget has become.
Watch the entire conversation with Fire Chief Robert Anderson Jr: (Part 1)
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Contact Fire Chief Robert Anderson Jr: [email protected]
Contact Cindy Green: https://linktr.ee/CindyGreen4VA
Contact John W Peace II: https://linktr.ee/JohnWPeace