Administration and Leadership

2004 JEMS 200 City Survey

Each year, JEMS surveys first responders and transport agencies from the metropolitan areas of the nation’s 200 most populous cities.

From Boston to Los Angeles, from Anchorage, Alaska, to Miami, from your part of America to ours, and everything in between, the survey aims to capture a feel for us all. The result is a unique glimpse into an ever-evolving industry. The 200-City Survey offers communities, providers, administrators and medical directors a snapshot of facts and trends that can be used to develop internal benchmarks.

Travel the urban centers of America and you begin to appreciate the diversity of each city’s geographical makeup. From cities like Boston, surrounded by heavily populated suburbs, to communities like Charlotte, N.C., where a medic can be working in the downtown urban center one minute and be out in rural farm country the next, the size and shape of service areas and the assortment of entities that cover them vary greatly.

The average geographic coverage area reported was 294 square miles. Forty-two percent of first responders and 69% of transport providers report that their coverage area extends beyond their city’s borders and includes service to surrounding communities. The range of populations served was dramatic, but the average of all those surveyed was 459,804. The population density was 1,564 people per square mile.

Whether you live in a small rural community or a big city, first responders are critical to the EMS system. Their ability to respond quickly has a substantive impact on the quality of care received. The fire service has long provided first response services. It continues to be the predominate provider, with 90% reporting that either single-(80%) or multi-role (10%) fire personnel provide medical first response. A combination of other entities—including hospitals and volunteer ambulance squads—provide first response in the remaining communities.

EMS in the United States has always included a melting pot of transport providers. Public, private, fire-based, volunteer and hospital-based are just a sampling of the models that currently exist. In recent years, the private, for-profit ambulance service model provided the majority of primary emergency transport. This year, that changed, and, for the first time, fire-based EMS moved to the forefront, with 42% reporting either single- (4%) or multi-role (38%) fire department personnel as the primary emergency transport provider.

An accurate reason for the shift cannot be made using the data itself. One explanation may simply be that it is a result of the makeup of this year’s survey respondents, but the shift may also reflect a change that has happened in recent years, involving communities transitioning from other models to a fire-based model. Further study is needed to determine if there is an actual trend toward fire-based EMS transport.

Private services are the second-largest provider type among the survey cities, representing 32% (with 28% for-profit and 4% not-for-profit). Third-service departments were 8% of the total, hospitals 6%, public utility model services 5%, volunteer squads 4%, with a host of other providers making up the balance.