The best EMS in SC for a small medical system doesn’t have a local hospital. Here’s why it’s great

Being a paramedic is no easy task, and rural emergency medical services definitely have their work cut out for them.

In less populated South Carolina counties, it’s increasingly likely that there are fewer medical services available for residents. Out of 46 counties, eight counties lack a general hospital or licensed surgical facility, according to a report from the SC State House.

Marlboro County is one of those counties, and as a result, its EMS is responsible for delivering patients to neighboring hospitals while providing advanced, life-saving medical care.

When patients call 911, Marlboro County EMS is the first and only point of care, and it can take up to an hour for patients to get definitive treatment.

Because of their ability to provide extended care with limited resources, Marlboro County EMS was named the 2025 Small System of the Year in a recent awards ceremony by the South Carolina EMS Association, a nonprofit organization that serves as the unified voice for emergency medical services professionals across the state.

“This is a testament to the dedication that our providers possess to continue to provide progressive prehospital care to our citizens and visitors,” Marlboro County EMS said in a Facebook post.

The Small System of the Year award goes to an ambulance service with fewer than 12,000 calls annually for outstanding professionalism and service to its community.

Here’s what else to know about the award-winning EMS system:

How Marlboro County EMS won

Serving approximately 25,500 residents, the Marlboro County EMS responds to more than 6,200 calls annually, averaging around one call every 90 minutes, according to a press release from SCEMSA.

With no hospital in its county’s border, the EMS functions as both an emergency response system and a critical access point to healthcare.

Patients who need extensive care are often transported to regional trauma centers and cardiac centers in Marlboro County, but transport times still range between 45 minutes and an hour. During transport, paramedics have to manage critically ill and injured patients without immediate hospital access.

Patients who need to go to the ER are transported to Marlboro’s surrounding counties, such as Dillon, Chesterfield and Florence.

To meet demand, Marlboro County EMS has implemented advanced clinical capabilities typically associated with larger systems.

Marlboro County EMS also carries and administers whole blood, which includes plasma, in the field, a capability available in only 1–2% of EMS agencies nationwide. This allows providers to begin life-saving transfusions for trauma patients before reaching the hospital, which is particularly critical in rural environments with extended transport times.

In addition to emergency response, the agency operates a Community Paramedic program focused on chronic disease management, home visits and reducing repeat utilization of 911 services.

In rural systems where transport times are extended and resources are limited, the ability to deliver advanced prehospital care is critical, according to SCEMSA. Marlboro County EMS demonstrates how targeted clinical investment and system design can expand access to care and improve patient outcomes in underserved areas.