One of the Most Efficient and Progressive Government Funded EMS Delivery Models

In earlier blog posts, I covered the general aspects of Emergency Medical Services within the 911 framework and the various delivery models employed to offer these services. In this post, I will explore the independent government-funded EMS delivery model in depth.

The Independent Government EMS Alliance (IGEMSA) is nearing its first anniversary. This group was formed following discussions among non-fire-based and non-profit EMS delivery models that receive some level of tax funding and aimed to enhance service and efficiency. We now have 48 member agencies, collectively handling 2.6 million responses annually and employing over 9,000 people. Our alliance includes agencies with as few as 4,000 responses annually and others with more than 140,000.

For a government entity, the options for EMS delivery models typically involve contracting with a for-profit ambulance service, utilizing fire-based EMS, or adopting single-role delivery models. Although each system has its advantages and disadvantages, this blog focuses specifically on the single-role model.

As mentioned earlier, IGEMSA has 48 member agencies that meet the independent delivery model criteria, including Boston EMS, Austin-Travis County EMS, Cleveland EMS, Denver Paramedics, Honolulu EMS, New Orleans EMS, Wake County EMS, Louisville EMS, Hennepin EMS, and many others. (Link to member agencies: https://www.igemsa.org/) We are just scratching the surface of the actual numbers of these agencies in the US and the populations they cover. Most government leaders probably have no idea that these agencies are independent and assume they are fire-based systems. IGEMSA's main goal is creating awareness of the efficiencies and progressive care that is being provided with this model.

Cities and counties should not quickly disregard the independent government-funded model simply due to unfamiliarity or because most others are fire-based or privatized. EMS agencies that are innovating and adapting based on data and best practices often become political targets for groups with different agendas, who may lack expertise or current knowledge in EMS service administration. However, this doesn't imply that these innovative agencies are flawless, as inadequate leadership and insufficient support from elected officials can sometimes lead to valid concerns about service quality.

Many of the current challenges in EMS involve funding, retention, pay, career progression, and fatigue. Although no model is flawless, surveys of IGMESA member agencies show that some of these challenges are being addressed.

• 98% have implemented work hour limits to enhance fatigue management and safety.

• 93% offer a career ladder that enables advancement within the organization without leaving patient care roles.

• 58% of agencies report average employee retention rates exceeding 5 years.

• 72% offer pay rates comparable to other public safety personnel.

This model emphasizes best practices in patient care and does not involve multi-role duties. A progressive example is the provision of pre-hospital blood in ground ambulances. As reported in a 2024 article on EMS.gov, only 2-3% of ground EMS agencies are providing blood in the field. Although this percentage is increasing, 38% of IGEMSA members are already administering blood in the field, with another 30% planning to implement it in the next year. Furthermore, 57% have advanced ventilators, and 40% possess ultrasound capabilities.

Opportunities for Efficiencies

This delivery model provides methods to enhance service while maintaining efficiency. However, many of these enhancements and efficiencies are often used to criticize the delivery model. Although there are opportunities, the truth is that public perception significantly impacts the decisions made by government leaders.

As the demand for EMS in the 911 context increases, the industry has evolved. 911 EMS systems now function as a public safety net and are often used for situations that don't require hospitalization. This change has led agencies to shift from responding urgently to every situation within minutes to adopting new tools and strategies. This evolution is akin to law enforcement developing new methods to carry out their duties. We wouldn't expect the same emergency response or timing metrics for all types of calls in law enforcement. However, when this concept is applied to EMS, it is frequently criticized as a system failure. There is a delicate balance between public perception and expectations and providing appropriate service efficiently.

One key opportunity to enhance response efficiency is through dynamic staffing. In busy EMS systems, it is uncommon for crews to work 24-hour shifts. While such shifts might be suitable in areas with lower call volumes, most agencies opt for 10- or 12-hour shifts. EMS is unique because call volumes are somewhat predictable based on the day and time. During weekdays, call volumes tend to be higher due to increased business activities and physical activities, whereas they drop at night when people are asleep. By utilizing data, dynamic staffing allows for deploying more ambulances during peak times and fewer during quieter periods. In a static system, the number of ambulances remains constant day and night, leading to system strain during busy periods and surplus capacity at other times.

The second aspect of efficiency involves regionalization, which is more commonly seen in non-fire-based EMS. Although the political framework in your region might not support this approach, it's difficult to deny that regionalization is more efficient and generally enhances patient care. For years, healthcare and hospital systems have been consolidating to adapt to evolving reimbursement models, staffing shortages, and increased service demands.

A third area of improved care and efficiency focuses on triaging 911 calls using an approved protocol at your public safety answering point. These systems provide alternatives to ambulance dispatch and help deliver lifesaving first aid instructions. The delay in response due to categorizing urgent versus non-urgent requests is often criticized as a system failure instead of adapting to the changing healthcare environment.

Your delivery model must be tailored to suit your specific circumstances. Although the independent model addresses numerous existing challenges in EMS, it can falter if not properly established and managed. This blog post aims to highlight this widespread model that might not be familiar to everyone. When county-based, independent single-role, healthcare district, and regionalized EMS delivery models are combined, they form a substantial model in the United States. IGEMSA seeks to provide information to assist you when making decisions about delivery models.