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Rural ambulance service in Oklahoma needs to be rescued, officials said.

Last year, the situation was described as dire when the state lost four rural ambulance services and many others struggled to remain operational.

In March, another was added to the list, leaving 50 ambulance services since 2000 that have closed their doors.

"Until we take some action, it's just going to get worse,” said Shawn Rogers, director of the Emergency Medical Services Division for the state Health Department.

In some areas, a neighboring service absorbs that area, but others are left without ambulance coverage. In about a dozen Oklahoma communities, ambulance service has been abandoned.

The core issue, Rogers said, is that rural Oklahoma is losing residents. The counties that are losing residents are the same ones struggling to maintain an ambulance service.

More than one-third of the state is supported by ambulance services that operated "in the red,” he said. Many complete less than 1,000 runs per year, and Medicare reimbursements don't cover their costs.

It is different in metropolitan areas, Rogers said, where the costs are spread among a high volume of calls.

Even if some patients cannot or will not pay, the expense is more easily absorbed.

Medicare insures more than half of EMS patients, and uninsured patients make up more than 30 percent.

Greg Reid, director of REACT EMS in Pottawatomie County, said another issue is that rural EMTs are paid far less than what they could make as a nurse or firefighter. They are also paid less than their counterparts in bigger cities.

"Financially, it's difficult to stay in their community,” he said.

Consolidating into regional ambulance services appears to be the best solution among officials.

"The key to efficiency is coordination. We have a poorly efficient system in need of coordination,” Rogers said.

A regional system would benefit from a high-quality dispatch system, Rogers said.

Currently, if you call for an ambulance in Mountain Park, in southwestern Oklahoma, you're calling the crew directly.

It's not that uncommon for rural ambulance services to self-dispatch to emergencies, he said.

Reid, who also chaired Gov. Brad Henry's ambulance task force, said he's hopeful the Legislature will take action on this issue before the session ends.

Several bills introduced last year never made it to a vote.

But Reid said he has seen positive signs, including the governor mentioning the crisis facing ambulance service in Oklahoma in his state of the state address and requesting funding for it in this year's budget.

It is a tough year for funding, Reid admits, but that's the only way to provide adequate ambulance service in the state.

"It's a complex problem with many issues, but the bottom line is the funds just don't exist,” he said.