By Cindy Green, fmr candidate for VA House of Delegates District 44

There is a sound folks in rural Virginia recognize without thinking. A siren cutting through the dark, rolling across hills and hollows, telling you someone needs help and neighbors are already on the way. That sound has carried our communities for generations.

But in too many small towns, that siren is close to falling silent.

Rural ambulance crews were built on the volunteer model nearly a century ago. Roanoke’s Life Saving and First Aid Crew, formed in nineteen twenty eight, is considered the first independent volunteer rescue squad in the country. Neighbors trained together, bought what equipment they could, and promised to answer the call.
https://www.yorkcounty.gov/DocumentCenter/View/32972/Virginia-Emergency-Medical-Services-Historical-Highlights

The idea was simple. If someone needed help, you went.

Today the work is harder, the calls more complex, and the volunteers fewer. Many rural counties have shrinking populations and long distances to cover. The New Yorker reported that some towns in rural Wyoming cannot find enough people to staff a single crew.
https://www.newyorker.com/news/dispatch/in-rural-america-there-are-few-people-left-to-drive-the-ambulances

It is not just happening out west. It is happening here too.

For many volunteer squads, Medicaid reimbursement has been the thin line keeping the trucks running. It covers fuel, medical supplies, and the basic costs of holding a crew together. The National Rural Health Association warned in two thousand nineteen that nearly one third of rural EMS agencies were already in immediate danger of shutting down.
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Proposed Medicaid cuts could break that line completely.

Volunteer agencies already stretch every dollar. They keep old ambulances running long past their prime. They rely on a handful of volunteers who give more hours than most people realize. When reimbursements drop, these squads cannot simply tighten the belt. They close their doors.

The AMA Journal of Ethics noted this year that rural EMS systems are so fragile that even a small reduction in funding can put entire counties into crisis.
https://journalofethics.ama-assn.org/article/how-should-rural-ems-funding-streams-be-improved/2025-07

What does that crisis look like?

It looks like calling 911 and waiting longer than your loved one can afford.
It looks like an ambulance coming from the next county because yours no longer has a crew.
It looks like families driving medical emergencies themselves because waiting is worse.
It looks like the night the siren never starts.

Rural hospitals have already closed across our region. EMS may fall even faster. Some rural communities in Wyoming have merged squads and hired part time crews just to keep one truck ready.

Virginia will face the same choices. Without steady Medicaid reimbursements, many rural EMS agencies will not survive.

Our communities have lost enough. We cannot afford to lose the people who show up when everything goes wrong. When your night turns bad, you want to know someone is on the road coming to help.

The time to protect rural EMS is right now.