Thank you, Dr. Rogers, for raising this important issue [in “Rural Hospitals Not Open for Business,” January 2015].

1. Rural critical access hospitals do provide important local services for select patients. Not every elderly pneumonia patient should be transported two hours to a tertiary hospital. The scope of services needs to be clearly defined and funded.
2. Rural critical access hospitals need systems of training and quality monitoring so that standards of care are met.
3. A nod of appreciation to ACEP Rural Section for endorsing comprehensive advanced life support training, a team-based, evidence-based training for rural emergency departments.
4. Regionally directed, adequately funded paramedic-staffed EMS is critical in addressing needs of rural communities.
5. The role of PAs certified in emergency medicine coupled with telemedicine is an effective and cost-effective way to deliver emergency care in rural hospitals or freestanding EDs.
6. All rural hospitals should establish close collaborative linkages with tertiary facilities for referral, consultation, training, and outreach.

ACEP and the Society of Emergency Medicine PAs need to lead advocacy efforts for comprehensive reform of rural emergency health care based on the above points.

—John Graykoski, PA-C, MPAS Colfax, Wisconsin