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The “National EMS Assessment,” released in December 2011 by the Federal Interagency Committee on Emergency Medical Services (FICEMS), validates that the fire service is the largest provider of EMS in the United States. This is something the fire service has believed all along, but unfortunately until now there was no data to support that belief. At times, American Medical Response (AMR) has called itself the largest provider of EMS in the United States, but the “National EMS Assessment” confirms this is untrue.
FICEMS was responsible for the commission of the study, with funding provided by the National Highway Traffic Safety Administration (NHTSA). The document describes EMS, emergency preparedness and 911 systems at the state and national levels using existing data sources. Quite frankly, it is the most comprehensive study of emergency medical service on a national level I have seen and it paints a good picture of how EMS is structured in the United States.
By the numbers
The 550-page study is a wide-ranging report describing the estimated 19,971 EMS agencies, their 81,295 vehicles and the 826,111 EMS professionals licensed and credentialed in the United States. Additionally, just under 37 million EMS events (responses) and an estimated 28 million EMS transports occurred in the United States in 2009.
If you look deep into the statistics, it is interesting to see the fire service’s profound impact on the EMS profession. For instance, a chart on page 43 of the assessment (see below) breaks down EMS agencies by organizational type. That chart reflects that 40%, or 6,388, of all EMS agencies are fire-based EMS. That is the highest among all categories. The next-closest category to fire-based EMS is private ambulance services that are not hospital-based, at 25% (3,910) and governmental agencies that operate EMS that are not fire-based, at 21% (3,255). This information does not include data from California, Illinois, Virginia and Washington state – all of which I think would have made the fire-based EMS percentage higher.
Even though the fire service is the largest provider of EMS transport in the United States, it would be an interesting statistic to see how many of the governmental and private ambulance providers still rely on the fire service to provide EMS through first response. Unfortunately, the study did not go that far.
When you look at the map of the United States on page 44 of the assessment, it appears that most fire-based EMS agencies are in northern states. Those states shaded in red have greater than 150 agencies that are licensed as fire-based EMS. These include Indiana, Iowa, Minnesota, Montana, Ohio, Pennsylvania and Wisconsin. The only two southern states are New Mexico and Texas. Again, data from California, Illinois, Virginia and Washington state was not available.
Another interesting piece of data that reflected that the fire service is the largest provider of EMS in the United States was found on page 122 of the report. When looking at credentialing of EMS professionals working by agency/organizational type, the report says, “There appears to be a fairly even distribution of EMS professionals across the EMS agency types with fire-based EMS maintaining the greatest percentage of EMS professionals.” According to the graph of the United States on page 123 of the report, the states with the largest percentage of credentialed fire personnel were Texas and Utah.
Other information that can be gleamed from the report indicates that over 93% of the EMS agencies respond to 911 emergency events either with transport capability (65%) or without transport capability (28%). Five percent of the licensed EMS organizations provide non-emergency medical transport services. Specialty care transport organizations comprised over 4% of the licensed EMS organizations and are almost equally divided between air medical and ground ambulances services. More than 51% of the EMS organizations function at the EMT-basic level, 38% at the EMT-paramedic level and 9% at the EMT-intermediate level.