Rural-Urban – An Emergency Is An Emergency

Imagine calling 9-1-1 in a desperate situation but no ambulance responds.  This exact scenario has already happened in several Wisconsin communities, and almost all services are struggling with a lack of funding and staffing shortages. Small towns and rural areas are particularly hard hit, with the pandemic accelerating the crisis dramatically. Because of this, the Wisconsin Office of Rural Health has launched a Rural EMS Outreach Program to assist struggling services and ensure that all citizens have sustainable access to Emergency Medical Services, regardless of their zip code. 

James Small has been hired as the Rural EMS Outreach Program Manager at the Wisconsin Office of Rural Health.  James has worked as a paramedic, firefighter, police detective, EMS/Fire Chief, and instructor in two colleges. He began as a First Responder in the Washington Island Rescue Squad in 1993, and has since worked in a variety of settings, from rural to urban, municipal to private. Most recently, he implemented an innovative model to combine Palmyra’s EMS, Fire, and Police Departments into one Public Safety organization, with a series of quality-improvement efforts that took them from a challenged system with inability to staff consistently to years of sustained reliability and high-quality patient care. 

Each community is unique, and the dynamics that challenge their Emergency Medical Service often require a custom response. The goal of the new Rural EMS Outreach Program is to provide an experienced advisor, a phone call or email away, who can sit down with service leadership and help develop a tailored plan to their dynamics, free of charge.  

The Rural EMS Outreach program ( can be contacted at (608) 265-8221 or