Annie Jackson is unsure if her sister Glenna Prude would have survived if an ambulance had arrived earlier when she went into cardiac arrest on May 10. Prude, 55, died on the steps of Carrollton City Hall, which was located less than a half-mile away from the county’s only ambulance station. At the time of the incident, two ambulances were on duty, with one transporting patients to Tuscaloosa, Alabama (a 45-minute drive), and the other transporting patients to Columbus, Mississippi (a 30-minute drive). The situation in Carrollton is not an isolated incident, as similar tragedies have occurred. The single ambulance station in Carrollton serves all of Pickens County, which has a population of nearly 20,000 people spread across 900 square miles. The county’s rural areas, where hospitals have closed, are particularly affected, as the nearest existing facility is a long drive away and ambulances are scarce.
In May, the Center for Rural Health Research and Policy released a study documenting disparities in the availability of ambulance services across the country, which they referred to as “ambulance deserts.” These are areas where people live more than 25 minutes away from the nearest ambulance station. The study found that 4.5 million people live in ambulance deserts in 41 states, with the majority of them residing in the South. Alabama had the second-highest number of people living in these areas, with 315,000 individuals.
Pickens County’s emergency services paint an even more dire picture. In March 2020, the 56-bed Pickens County Medical Center closed due to unsustainable financial conditions and declining patient volume. As a result, residents of Pickens County often have to wait nearly 30 minutes for an ambulance to arrive, and then travel up to an hour by ambulance to reach a hospital in Tuscaloosa or Columbus. The closure of the hospital has had significant financial implications for the ambulance service, resulting in a loss of approximately $250,000 per year in revenue. Recruitment of paramedics and other healthcare providers has also become challenging due to the stress and strain of working in the county.
The decline of healthcare resources in rural areas is not unique to Pickens County. Over the years, many rural areas across the United States have experienced a decrease in resources. In the past, only funeral homes in Pickens County provided ambulance services, with hearses being used to transport patients. However, after the development of a hospital in the county, a modern ambulance service was established. Advancements in medical technology and changes in the healthcare landscape have contributed to the closure of rural hospitals like the Pickens County Medical Center. People in these communities believe that small hospitals play a crucial role in providing healthcare services and are dismayed by their closures.
Community leaders in Pickens County believed they had a viable plan to revitalize the hospital by reopening emergency rooms and operating youth mental health facilities. They requested $10 million from the state Legislature for this project, which was later reduced to $8 million. The funds seemed promising, but at the last minute, the Senate halted the cash infusion, leaving the hospital project in limbo. This issue highlights the challenges faced by rural areas when it comes to emergency medical needs. With the decline of rural hospitals and ambulance services, the burden falls on the remaining services to provide sophisticated emergency care, even though their primary role is not meant to replace emergency departments.
The fragmented nature of ambulance services, particularly in rural areas, further exacerbates the challenges faced by residents. Ambulance stations are spread thin, and the lack of available services leaves rural communities underserved. The people of Pickens County and other rural areas are fighting to bring attention to their plight. They have made trips to the Alabama State Capitol to protest lawmakers’ decisions to defund hospitals and to advocate for better healthcare services in their communities. The loss of essential rural health services has far-reaching consequences on both the health and economic well-being of these communities. It is clear that rural healthcare is in dire need of attention and support to prevent further decline.