When Healthcare Is Miles Away, Bring It Closer
A semi-truck hauling two FORTS Standard units across highway to rural city.
In Rural Healthcare, Distance Changes Everything
Imagine experiencing chest pain in a major city. An ambulance arrives, and within minutes, you’re on your way to an emergency room. Now imagine the same emergency in a rural community, where the nearest hospital may already be miles away and suddenly, that hospital can no longer operate. Maybe a hurricane damaged the roof or a burst pipe flooded a clinical wing. No matter what, repairs or renovations will temporarily eliminate critical patient-care. The hospital, doctors, nurses and equipment may still be available but what’s missing is the space to provide it. In a metropolitan area surrounded by hospitals, losing one facility creates a serious disruption. In an isolated rural community, the consequences can be far greater.
Healthcare doesn’t disappear when the building goes offline. It simply moves farther away.
FORTS USA
What if healthcare infrastructure could move instead?
When the Hospital Closes, the Road to Healthcare Gets Longer
We already know what happens when rural communities lose access to a hospital and the consequences should be concerning. A U.S. Government Accountability Office analysis of rural hospital closures found that affected residents had to travel approximately 20 additional miles for common healthcare services such as inpatient care, and approximately 40 additional miles for certain less-common services. Many of these communities were already facing shortages of healthcare professionals, and physician availability declined even further after their hospitals closed. And the problem continues.
The Health Resources and Services Administration reports that 152 rural hospitals closed between 2010 and 2025, including 52 Critical Access Hospitals. But additional mileage tells only part of the story. Research examining emergency medical services before and after rural hospital closures found that closures increased EMS transport times. For patients experiencing a stroke, major trauma, cardiac emergency, obstetric complication, or another time-sensitive medical crisis, those additional minutes and miles can carry serious consequences. In rural healthcare, distance isn't simply an inconvenience. When every minute matters, distance can become a clinical risk.
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If we already know what happens when rural healthcare moves farther away, shouldn't keeping healthcare close be part of the continuity strategy?
Washington Already Recognizes That Geography Matters
Federal healthcare policy has acknowledged for decades that rural healthcare cannot always operate under the same model as healthcare in major metropolitan areas. One of the clearest examples is the Critical Access Hospital (CAH) program. CAHs are small rural hospitals operating under special Medicare requirements. Among the geographic criteria, a CAH generally must be located more than a 35-mile drive from another hospital, with different standards applying in certain mountainous areas or locations served by secondary roads. Qualifying CAHs receive Medicare reimbursement for many inpatient and outpatient services based on 101% of reasonable costs. Consider what is embedded in that policy. Distance from another hospital matters enough to be incorporated into federal healthcare policy.
The Rural Emergency Hospital, Keeping Essential Care Local
Beginning in 2023, Medicare established a new provider category: the Rural Emergency Hospital (REH). The concept addresses a difficult reality. Some rural hospitals cannot economically sustain the traditional inpatient hospital model. But allowing the hospital to disappear entirely can leave a community without meaningful local access to emergency care. The REH model provides another option. Eligible facilities can discontinue inpatient hospital services while maintaining emergency, observation and other outpatient services. Qualifying REHs receive an additional 5% Medicare payment for covered REH services over the applicable outpatient payment rate, along with an additional monthly facility payment. A 2026 study published in JAMA Network Open described the REH program as an effort to preserve healthcare access amid continuing rural hospital closures. The underlying principle is significant: Maintaining essential healthcare capability close to the community matters even when the traditional hospital model has to change. But CAH and REH policies primarily address another kind of resilience, financial resilience. But what happens when the problem isn't reimbursement?
What happens when the problem is the building?
Financial Resilience Is Not Physical Resilience
A hospital can have favorable Medicare reimbursement and still lose its roof. It can maintain certification and still suffer a catastrophic plumbing failure. It can have physicians, nurses and equipment while its emergency department undergoes major renovation. It can have patients waiting for care while construction renders part of the building unusable. It can have an emergency preparedness plan and still have nowhere to physically put the patients. That means every rural healthcare organization should be asking two separate continuity questions:
1. How do we keep the healthcare organization operating?
2. How do we keep physical healthcare capacity available?
Those aren't the same problem. And too often, healthcare continuity planning concentrates on the first while assuming the building will remain available for the second.
The Building Is a Single Point of Failure
Hospitals spend enormous resources preparing for operational disruption. Backup generators protect against electrical failure. Redundant communications protect connectivity. Cybersecurity protects information systems. Emergency plans establish command structures. Mutual-aid agreements identify outside resources. Insurance transfers certain financial risks. But eventually, all of those systems depend upon something remarkably basic, a physical place where care can happen. If that space becomes unusable, redundancy elsewhere in the organization doesn't automatically replace it. A hospital doesn't need to permanently close to create a healthcare access problem.
It only needs to become temporarily unusable.
Your Emergency Plan May Tell You What to Do. But Does It Tell You Where to Do It?
Medicare-participating healthcare providers already operate under federal emergency-preparedness requirements. CMS states that its Emergency Preparedness Rule establishes national requirements intended to ensure healthcare organizations adequately plan for natural and human-caused disasters and coordinate with federal, state, tribal, regional and local emergency-preparedness systems. Compliance with applicable emergency-preparedness regulations is required for participation in Medicare and Medicaid. So most hospitals have plans. But look closely at what many traditional continuity measures actually provide. An emergency plan identifies what happens next. A communication plan identifies who makes the calls. An evacuation plan identifies where patients are transferred. A mutual-aid agreement identifies who may be able to help. Those measures are critical. But none of them automatically creates a single additional square foot of clinical space.
Continuity planning answers: “What will we do?” Physical continuity asks another question: “Where will we do it?”
That is the infrastructure gap.
What If Healthcare Infrastructure Could Move?
This isn't simply a theoretical idea. Disaster-medicine researchers have studied portable and temporary healthcare facilities for years. A comprehensive review published in Prehospital and Disaster Medicine examined portable healthcare facilities ranging from mobile hospitals to solid-container temporary facilities. Researchers identified important characteristics for future portable healthcare infrastructure, including speed to operation, accessibility, sustainability, flexibility and modularity. Those characteristics closely resemble the requirements of a rural healthcare organization that suddenly loses clinical space. A 2025 scoping review published in BMC Health Services Research examined nearly 3,000 documents concerning mobile health units used following earthquakes, floods, tsunamis, hurricanes, typhoons, cyclones, landslides and other disasters. Researchers found mobile health units being used to improve healthcare access where normal services had become difficult to reach. They also identified challenges involving logistics, transportation, referral capacity and communications. That distinction is important. The lesson isn't simply buy a mobile clinic.
The larger lesson is:
Deployable healthcare capacity works best when it is planned as infrastructure not improvised after infrastructure fails.
The Missing Layer: Physical Continuity
This is where deployable medical infrastructure deserves a place in the rural healthcare conversation. Instead of assuming that temporary healthcare means sending patients somewhere else, consider another possibility. Bring healthcare capacity closer to the patients. FORTS® deployable medical infrastructure provides hard-walled, rapidly deployable facilities capable of being configured for medical and other critical operations.
Depending upon the configuration, clinical requirements, site and applicable regulatory approvals, deployable infrastructure can potentially provide temporary capacity adjacent to an existing hospital, at another approved location, or as part of a larger healthcare continuity operation.
Potential applications can include:
temporary clinical and examination space
medical surge capacity
emergency or outpatient support functions
replacement space during renovation
disaster recovery operations
isolation or specialty-care functions
administrative and command operations
temporary healthcare expansion
The distinction from simply putting a clinic inside a conventional trailer matters. The objective is not mobility for mobility's sake. The objective is rapidly deployable physical infrastructure capable of supporting serious healthcare operations when permanent infrastructure is unavailable, damaged or insufficient.
Could Deployable Infrastructure Support CAH or REH Continuity?
This is where healthcare executives should separate a sound infrastructure strategy from an unsupported reimbursement promise.
Deploying a temporary medical facility does not automatically guarantee continued Critical Access Hospital or Rural Emergency Hospital certification or Medicare reimbursement. CMS Conditions of Participation, state hospital licensing requirements, provider enrollment, approved locations, life-safety requirements, scope of services, reimbursement rules and other regulatory requirements may apply. Every hospital, deployment and clinical configuration must be evaluated individually. But that regulatory reality shouldn't end the conversation. It should start the planning process.
Because if an organization waits until its clinical space is already unusable to determine whether temporary infrastructure can be licensed, connected, staffed and operated, it is solving the problem at precisely the wrong time. The better question is: If healthcare can be delivered safely, legally and appropriately from approved temporary infrastructure, why should the loss of a building automatically mean the loss of local healthcare capacity?
Plan the Space Before You Need the Space
Hospitals don't buy fire extinguishers after the fire. They don't write evacuation plans while the hurricane makes landfall. They don't begin cybersecurity planning after ransomware has encrypted the network. Physical continuity deserves the same discipline.
Before a disruption occurs, a rural hospital or health system can determine:
Where could temporary medical infrastructure be located?
What utilities would be required?
What clinical functions could relocate?
What equipment would need to move?
How would patients flow through the temporary facility?
What life-safety requirements would apply?
What state approvals would be necessary?
What would CMS require?
How would the temporary space integrate with the remaining hospital?
How quickly could it become operational?
And who would actually provide the infrastructure?
What happens when every hospital hit by the same hurricane, wildfire, flood, or regional disaster looks for temporary medical facilities at once?
This isn't just a procurement issue it's a preparedness issue.
Preparedness must be solved before the emergency creates the demand.
From Emergency Preparedness to Physical Continuity
Healthcare has traditionally thought about redundancy in terms of systems. Backup power. Backup communications. Backup data. Backup suppliers. Backup staffing. Perhaps rural healthcare should start thinking about backup space the same way. That doesn't necessarily mean maintaining an empty second hospital. Modern deployable infrastructure creates another possibility: Maintain access to infrastructure that can be transported, deployed and configured when permanent capacity is disrupted. That turns temporary healthcare space from an emergency purchase into a continuity asset. And it changes the planning question from: "Where will we send everyone?" to: “How much healthcare capacity can we keep local?” For an isolated community, that distinction can mean dozens of miles.
The Hospital of the Future May Not Always Be a Building
Three facts matter. Research shows that when rural hospitals close, people must travel farther, access to care falls, and emergency transport takes longer. Federal policy recognizes geography matters programs like Critical Access Hospitals and Rural Emergency Hospitals exist because rural areas need different solutions than cities. Disaster-medicine research shows care capacity can be moved, portable, temporary medical facilities can provide care when buildings aren’t available. Together, these facts point to a new model: rural healthcare should not rely only on keeping every hospital building open. It should also ensure medical infrastructure can move when buildings can’t.
When Healthcare Is Miles Away, Bring It Closer
When a rural hospital closes for good, distance becomes a community problem. But when a hospital temporarily loses capacity due to construction, renovation, disaster, infrastructure failure, or other disruption distance doesn’t have to be the only option.
Bring care to the need.
FORTS® delivers deployable medical infrastructure for organizations that can’t wait for permanent construction. This is not a replacement for long-term planning, a guarantee of reimbursement or regulatory approval, or just an emergency trailer. It’s a physical continuity strategy for when the hospital building is unavailable so healthcare can continue.
Ask at your next leadership meeting: If our primary clinical space became unavailable tomorrow, where would we deliver care for the next 30, 90, or 180 days? If the answer is “another hospital 40 miles away,” that’s a transfer plan not a continuity solution.
Talk to FORTS® about planning deployable medical infrastructure before temporary space becomes an emergency need.
Research & Government Sources
U.S. Government Accountability Office
Rural Hospital Closures: Affected Residents Had Reduced Access to Health Care Services (GAO-21-93)
Health Resources and Services Administration
Rural Hospital Programs and rural hospital closure data
Miller et al.
The Effect of Rural Hospital Closures on Emergency Medical Service Response and Transport Times
Centers for Medicare & Medicaid Services
Critical Access Hospital certification, eligibility and reimbursement guidance
Centers for Medicare & Medicaid Services
Rural Emergency Hospital program, Conditions of Participation and payment policies
JAMA Network Open (2026)
Early Evaluation of the Rural Emergency Hospital Program
Bitterman & Zimmer — Prehospital and Disaster Medicine
Portable Health Care Facilities in Disaster and Rescue Zones: Characteristics and Future Suggestions
Sheerazi, Awad & von Schreeb — BMC Health Services Research (2025)
Use of Mobile Health Units in Natural Disasters: A Scoping Review
Centers for Medicare & Medicaid Services
Emergency Preparedness Rule and provider guidance
