For emergency medical cyber-physical systems, enhancing the safety and effectiveness of patient care, especially in rural areas, is essential. While the doctor to patient ratio in the United States is 30 to 10,000 in large metropolitan areas, it is only 5 to 10,000 in most rural areas; and the highest death rates are often found in the most rural counties . Use of telecommunication technologies can enhance effectiveness and safety of emergency ambulance transport of patients from rural areas to a regional center hospital. It enables remote monitoring of patients by the physicians at the center hospital and provides vital assistance to the emergency medical technicians (EMT) to associate best treatments. However, the communication along the roads in rural areas can range from 4G to 2G to low speed satellite links, with some parts suffering from communication breakage. This unreliable and limited communication bandwidth together with the produced mass of clinical data and the many information exchanges pose a major challenge in real-time supervision of patients. During this research, we are developing a novel adaptive physiology-aware communication architecture which is aware of the patient condition, the underlying network bandwidth, and the criticality of clinical data in the context of the specific disease to achieve an enhanced remote monitoring. Further, it features reliability, safety, and fault tolerance for cases such as network interruption.