Government Entities and Emergency Medical Services-Delivery Models

Kicking off the new year, we’re launching a blog series tailored for government officials, both elected and appointed. The topics and level of detail will be designed specifically for this audience. Each post will build on the last, aiming to create a clear, easy-to-follow framework for understanding how EMS is provided in the United States.

In EMS, there’s an ongoing debate about whether responding to and treating or transporting patients should be viewed as a business or a public service. Things get even more heated when discussing whether we belong to the healthcare system or the public safety system. The aim here, and in future posts, isn’t to take sides in that debate, but to share some insight into why these issues exist. While many of these topics deserve a deeper dive, for now we’ll just skim the surface to lay a foundation of understanding.

Ambulance, bus, truck, box, “a ride,” driver, EMT, paramedic, EMS, first responder, critical care paramedic, community paramedic, paramedicine, mobile integrated healthcare, medic, squad, and more are all terms you might hear when talking about EMS. Many are regional, while others have become common but are considered derogatory in the EMS world—like calling EMTs and paramedics “ambulance drivers.” Though often unintentional, it’s worth thinking about how it would sound if we referred to other public safety roles as “police car drivers,” “radio talkers” for 911 dispatchers, or “fire truck drivers.” These varied terms can be confusing, but they also reflect the complexity of EMS and the healthcare system. Unfortunately, inconsistent terminology and focusing on tasks like driving instead of patient care can impact leadership decisions about how this service is delivered to the community.

Delivery Models

As mentioned earlier, the Independent Government EMS Alliance (IGEMSA) is a non-profit organization that brings together government-funded, single-role EMS delivery models. While our goal is to highlight and educate on the benefits of this approach, the truth is that every model has its own pros and cons.

Independent Government or Third Service refers to government-run EMS operating as its own public safety department, separate from police and fire. We use the term Independent Government EMS instead of Third Service because there are many variations of this model that provide EMS and receive partial government funding. Examples include regional healthcare districts, county hospitals, countywide EMS, and public-private partnerships, among others.

Public Utility Model (PUM) -In this model, the EMS system operates like a public utility such as water or electricity. A government or quasi-government oversight authority owns the assets and manages financial operations to serve the public interest. Most of the time, the authority contracts the actual ambulance services to a private company. Examples include Sunstar Paramedics in Pinellas County, Florida, Richmond Ambulance Authority in Virginia, and MEDIC in Mecklenburg County, North Carolina.

Fire-based EMS departments that offer ambulance transport usually fall into two types. The first is a dual-role setup, where personnel are trained as both firefighters and EMTs or paramedics. The second is a separate division within the fire department that doesn’t require dual roles. Non-dual role examples include the New York City and Chicago Fire Departments, while Los Angeles City, Dallas, and Miami-Dade are known for their dual-role systems.

Private and contract EMS services in the United States are provided by a mix of non-profit and for-profit companies offering ambulance coverage for municipalities. These services are often awarded through bids, either covering all ambulance responses and transports or specific types. Depending on the location and contract terms, some providers receive subsidies in addition to payments from insurance companies. Notable examples include American Medical Response (AMR, part of Global Medical Response), Falck, Acadian, Superior, and others. These organizations also play a key role in transferring patients between hospitals and different levels of care, and in many rural or volunteer-run areas, they provide much-needed paramedic-level support.

Hospital Based Services non-government - Hospital-based EMS is common across the US in both cities and rural communities. In many rural areas, a hospital-run ambulance might serve as a 911 responder, handle patient transfers to higher-level care facilities, and even help support the emergency department and hospital staff. There are also specialty transport teams that operate by ground or air ambulance, typically focusing on critical care for both adults and children.

As future blog posts will reveal, there’s no single perfect system that works for everyone. Expectations for service and care vary depending on location, yet many decisions about which model to use are based on inaccurate assumptions about profitability and the type of system considered for a community—often requiring extra resources and funding. Up next, we’ll explore ambulance usage in both the 911 system and the healthcare system, which differ greatly in approach, needs, and cost. And then there’s the ongoing debate: are we healthcare or public safety?

Upcoming Blog Topics

• HEALTHCARE SYSTEM CHANGES THAT IMPACT EMS IN BOTH COST AND VOLUME

• HOW TO MEASURE THE EFFECTIVENESS OF YOUR SYSTEM AND WHY LOOKING AT RESPONSE TIMES IS NOT THE ANSWER IN MOST SITUATIONS.

• CHARGING FOR AMBULANCE SERVICE AS A GOVERNMENT ENTITY AND WHY CHARGES MAY BE DIFFERENT DEPENDING ON YOUR LOCATION AND WHO RESPONDS.