HJAR May/Jun 2026

44 MAY / JUN 2026 I  HEALTHCARE JOURNAL OF ARKANSAS RURAL HEALTH COLUMN RURAL HEALTH THE state of emergency medical services (EMS) in Arkansas has been in flux for several years. Since 2015, EMS leaders across the state have warned of a growing workforce shortage — one that was significantly compounded by the COVID-19 pandemic. Today, that strain is evident across staffing, scheduling, funding, and long-term sustainability. While some progress has beenmade, it has not kept pace with broader economic, technological, and healthcare demands. The simplest way to understand EMS in Arkansas is this: The public expects an ambulance when 911 is called, but the system remains financed as a patchwork of transport payments, local arrangements, and limited public support. That tension is visible across the state. Increasingly, EMSmust be understood not as a transportation service, but as a critical component of the healthcare delivery system — serving as the front line of prehospital care, particularly in rural communities where access to traditional care continues to decline. “We are at a pivotal point in pre- hospital care inArkansas,”said Clay Hobbs, chief operating officer of Pafford Emergency Medical Services, one of the largest andmost influential EMS providers in the region with a substantial operational footprint across Arkansas and the broader mid-South. “With the continued closure of hospitals and key service lines — including obstetrics — the role of EMS is rapidly evolving. In many rural communities, EMS providers are no longer just transporting patients; they are becoming the primary point of care. That shift, combined with workforce shortages, reimbursement challenges, and increasing demand, is placing an unsustainable burden on the system. If we do not address support, resources, and system design now, we risk further destabilizing access to care across rural Arkansas.” A WORKFORCE UNDER STRAIN This shift is unfolding alongside persistent workforce challenges. EMS personnel consistently cite low pay relative to other healthcare professions, difficult working conditions, and a high-stress environment that contributes to burnout, injuries, safety concerns, and mental health strain. Additional issues include outdated equipment, limited professional advancement, and a lack of consistent recognition as part of the broader healthcare workforce. The wage gap further highlights the issue. In 2024, emergency medical technicians (EMTs) earned a mean annual wage of $34,453, while paramedics earned $47,298. By comparison, licensed practical nurses (LPNs) earned $49,359 and registered nurses (RNs) earned $72,897. Low wages continue to challenge recruitment and retention in an already strained workforce. “Too often, the only way providers can earn a livable income is through excessive overtime, sometimes working 72 to 96 hours at a time, raising serious concerns for safety, decision-making, and long-term sustain- ability. If we want to retain providers, we must address pay, equipment, scheduling, Workforce strain, shifting care delivery, and system transformation are redefining the future of EMS across Arkansas REDEFINING THE FRONT LINE: EMS & the Future of Care in Arkansas