Administration and Leadership, Patient Care

NASEMSO Survey Provides Snapshot of EMS Industry

Issue 1 and Volume 37.

Until now, even the most basic information about EMS has been unknown or inaccurate. How many EMS agencies and EMS professionals are there in the U.S.? How many 9-1-1 responses do they run annually? For the most part, any information on a national scale was a guesstimate at best.

That all changed when the EMS Performance Improvement Center at University of North Carolina (UNC) at Chapel Hill contacted the National Association of State EMS Officials (NASEMSO) with the idea for collaborating on an innovative project to collect nationwide data in a first-of-its-kind, comprehensive study.

“We thought it was a good idea and pledged our support to get the surveys out there and get them completed,” says Randy Kuykendall, NASEMSO president and deputy director, Health Facilities and EMS Division, Colorado Department of Public Health and Environment.

NASEMSO distributed iPads, provided by UNC, to each of its 56 U.S. state and territorial EMS offices. In return, the state officials were required to complete a survey using an iForm application on the device.

The survey was completed between October 2010 and March 2011. Despite technical issues involving transmission errors and connection challenges, all 50 states and four of the six territories participated. American Samoa and the District of Columbia did not to take part. The result is the widest ranging survey to date of EMS systems in the U.S.

According to Greg Mears, MD, associate professor and director of innovation at the University of North Carolina-Chapel Hill Department of Emergency Medicine, the survey was based on the original EMS components defined within the EMS Agenda for the Future and contained nearly 200 informational items. At the 2011 NASEMSO annual meeting held in October in Madison, Wis., Mears presented the findings. He began by telling the gathered EMS officials that, according to the survey, the number of credentialed EMS agencies is 19,437. Of those, 65% provide first response with transport capability. Another 28% provide first response without transport. Mears also provided numbers for medical transport and specialty care transport, but he cautioned that these figures could be skewed because many states don’t track this information.

The study results revealed that there are 78,258 credentialed EMS vehicles in the U.S., or three for every 10,000 people. Mears says access is more or less consistent throughout the country in areas with similar populations. The majority (55%) of the vehicles are ALS-transport capable.

More than 51% of the EMS agencies function at the EMT-Basic level, 9% at the EMT-intermediate level and 38% at the EMT-paramedic level.

The Face of EMS
The survey found a total of 826,111 credentialed EMS professionals at the EMT-B, intermediate and paramedic levels in the U.S. Mears says first responders weren’t included in the data because the definition of that job varies widely. Again, this number is fairly stable throughout the country, with 30 professional EMS responders per 10,000 of people. The majority of those responders are EMT-Bs (64%), with 24% identified at EMT-P and 6% as EMT-I.

Within the EMS workforce, 67% are male and 75% are Caucasian. “We’re still a very Caucasian male workforce,” Mears says. One in seven EMTs are between the ages of 20 and 49. The survey revealed that 8,459 local medical directors oversee EMS agencies in this country. “We’ve never known that before,” Mears says.

Data Collection and Use:
The survey looked at the number of states using an EMS data system based on the NEMSIS standard. Of the 50 states, 44 (88%) reported their data system complies with this standard. However, only 22% of those states collect 100% of their EMS events. Nearly eight of 10 require local data collection and submission to the state data system through regulation or state law.

Regarding how the data is used, 42% of the states reported that they use it to monitor public health for disease outbreaks and acts of terrorism, while 40% use it to link to other healthcare data. Trauma was the most common linkage.

More than 60% of the states participate in the national EMS database. Mears notes that participation in the national database has grown considerably in the past few years, allowing researchers to further analyze event types.

Disaster Preparedness: State EMS officials were asked to indicate whether they actively participate in the Assistant Secretary for Preparedness and Response Program (ASPR ESF-8). More than 80% replied that they do; however, only a small number are funded. Seventy-four percent said their local EMS agencies participate in the program. A slightly larger percentage (88%) actively participates in the Hospital Preparedness Program (HSGP), but again, few are funded.

Although 44% of state EMS offices participated in at least one CBRNE mass-casualty exercise in 2010, only 14% of the states have a requirement for local agencies to hold or participate in a similar exercise. The majority of exercises were related to biological entities, such as pandemic influenza.

Communications: According to the survey, only 66% of the states reported that Wireless Enhanced 9-1-1 was available within 70% or more of their geography and population. Only 30% of the states have the capability to track the number of 9-1-1 calls requesting EMS services and a mere 22% are able to track the number of 9-1-1 EMS dispatches.

More than 75% of the states indicated that state and local EMS or emergency management entities can communicate with each other via e-mail, text messaging or paging during normal or disaster operations.

Barely one third (36%) of all states credential the emergency medical dispatch centers that operate within their borders. Mears notes that more attention must be paid to EMS communications. “The next frontier in EMS is focusing on dispatch,” he says.

Responses and Patient Care: For 2009, there were an estimated 36,698,670 EMS events (responses) in the U.S., resulting in approximately 28,004,624 transports.

Half of all states have developed EMS protocols at a state level then implemented locally. The remaining states use locally implemented protocols without statewide coordination.

Fifty percent of the states maintain a list of medications at the state level that have been approved for use by EMS at the various professional levels. The other half relies on local EMS medical directors to determine medication use. Two-thirds of the states allow the local medical director to determine medical procedures use by professional level.

Workforce Health and Safety: Mears states that this is another target area for the future. According to the survey results, only 24% of states maintain a formal, recommended wellness and prevention program for EMS professionals. Although 36% of the states monitor EMS on-the-job fatalities and 22% monitor EMS vehicle crash data, only one state currently monitors EMS on-the-job injury data.

A key to projected funding is to determine the average cost and reimbursement for a 9-1-1-based EMS ground transport. Currently, only 6% of the states have attempted to make that determination. “This will be another area that will be important to us in the future,” Mears says.

On average, state EMS offices receive 33% of their funding from the state’s general budget. Another 19% of the states receive funding from motor vehicle-related fines or fees. Seven percent comes from federal preparedness funds. Various other funding sources account for the less than 5% each.

Only a couple of questions were asked regarding the respondents’ feelings about the state of EMS. Mears reports that 49% of the respondents disagreed with the statement that the number of EMS agencies is declining. Only 17% agreed with that statement. On the other hand, 77% agreed that volunteer EMS services are on the decline.

Mears says the state directors have been encouraged to keep their iPads with the expectation they will be asked to participate in further surveys. According to Kuykendall no plans are in place at this time for another survey. However, NASEMSO looks forward to participating in future studies.

Kuykendall says the association is pleased with the initial EMS study. “The results are pretty astounding,” he says. For the first time in its 40-plus year history, EMS professionals have current, nationwide data. “I have more information to make choices with than I’ve ever had before. Ultimately, this allows us to make more informed decisions on how we do our work,” he says.

Once the report has cleared the final review process, the entire 436-page document of research results will be posted on the NASEMSO website ( By clicking on a map, data can be accessed by state. Individual EMS agency data isn’t available. JEMS

This article originally appeared in January 2012 JEMS as “And the Survey Says: NASEMSO analysis provides snapshot of EMS industry.”