Thanks for the responses last week. I am crowdsourcing this research instead of using artificial intelligence because AI cannot provide nuance and perspective that you have as an experienced subject matter expert.
This week’s asks:
- Is there a breakdown by percentage, number of ambulances, or employees of EMS Service by agency (fire department, private for profit, municipal, community owned, hospital, or public utility model) newer than 2017?
- Is there a post-pandemic report on the workload of interfacility and authorized medical transports?
- Should there be more emphasis on the risk/reward when using air ambulances?
- Follow-up: Still looking for a short (5-minute) video describing a private/commercial EMS service that does both 9-1-1 and interfacility transports
You can answer by emailing michaelward@isu.edu or posting a reply below.
Why no textbook?
I contacted the publishers of the textbooks used for EMS Systems, and EMS Management/Operations courses. The existing books have copyright dates between 2015 and 2017. Much of their content is aging out. The publishers and editors said that they have no plans to update their books. The market for EMS systems, management, and operations books is tiny, with few sales.
2: Structuring EMS Operations
Skip Kirkwood, Rob Luckritz, Art Groux, Robert Waddell, and Mike Touchstone provided a great “Corporate Models for Ambulance Service Delivery” and Matt Zavadsky clearly described “Levels of Ambulance Service” in the Management of Ambulance Services (2015) textbook.
The lecture describes the different clinical levels of EMS care, and reviews the National Association of EMT’s “What is EMS?” description. We provide a more in-depth description of the five versions of the Emergency Ambulance Service with examples:
- Fire-Based (single role provider: FDNY – dual role provider: Fairfax County)
- Private for profit (AMR, Falck, and Acadian)
- Municipal (non-fire) (Wake County, Boston, and Indianapolis)
- Community-owned non-profit (New Jersey, and Virginia Beach)
- Hospital operated (New Jersey, and Atlanta)
- Public Utility Model (Richmond)
Mention of the impact of rural hospital closings on EMS.
The Small Group Activity is to prepare a presentation at the start of next LIVE session that advocates for one of the following versions of ambulance service for River County:
- Contracting with a commercial ambulance service. (Green team)
- River County government establishes and runs the ambulance service. (Yellow Team)
- Columbia City Fire Department establishes and runs a countywide emergency ambulance service. (Red Team)
Required reading/watching:
NAEMT (2024) What is EMS?
VB Rescue Foundation (2022) We are VB rescue [3:26] – Announcing the rebranding of the ten independent rescue squads and Virginia Beach EMS agency.
3: Scheduled Transport and Air Operations
Explain the workload of scheduled medical transportation. Describe the CMS description of medical and non-medical transportation for insurance reimbursement.
Review the Emergency Triage and Transport (ET3) initiative and why it was prematurely closed.
Provide detailed information on River County interfacility transports. As an Individual Assignment, have the student decide whether our RFP response should include providing the interfacility transports currently performed by the hospital-based ambulance service that is closing. The assignment requires an evaluation of data and revenue.
Describe air ambulance operations and the different agencies that provide the service. Review the 2021 Joint Position Statement and Resource Document of NAEMSP, ACEP, and AMPA in Prehospital Emergency Care.
Using the 2021 ASPE Issue Brief, discuss the cost, billing, and reimbursement of air ambulance services, including the “out-of-network” issue.
Mid Term exam question preview: Provided detailed information on recent history of medevac transports, including agency and geographic information, develop a Bengal Mobile Health Best Practice Operating Guide.
Required reading:
Blutinger, E., Ulintz, A. J., Chason, K. Gavin. N.(2025) ๐๐๐๐ซ๐ง๐ข๐ง๐ ๐ ๐ซ๐จ๐ฆ ๐๐ก๐ ๐ ๐๐ข๐ฅ๐ฎ๐ซ๐ ๐๐ ๐ ๐๐๐ ๐๐ฆ๐๐ซ๐ ๐๐ง๐๐ฒ ๐๐๐๐ข๐๐๐ฅ ๐๐๐ซ๐ฏ๐ข๐๐๐ฌ ๐๐จ๐๐๐ฅ Health Affairs. https://www.healthaffairs.org/content/forefront/learning-failure-cms-emergency-medical-services-model
Viitanen, A., Richardson, A., et. al. (2024) Breaking Point: Unraveling the Strain on EMS in Colorado and the Rising Role of Interfacility Transports
Lyng, J. W., Braithwaite, S., Abraham, H., Brent, C. M., Meurer, D. A., Torres, A., โฆ Larrimore, A. (2021). Appropriate Air Medical Services Utilization and Recommendations for Integration of Air Medical Services Resources into the EMS System of Care: A Joint Position Statement and Resource Document of NAEMSP, ACEP, and AMPA. Prehospital Emergency Care, 25(6), 854โ873. https://doi.org/10.1080/10903127.2021.1967534
Turrini, G., Ruhter, J., Chappel, A. R., & De Lew. N. (2021 Sept 10) Issue Brief: Air Ambulance Use and Surprise Billing. Office of Health Policy, Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services.
Reference: CMS (2025 January 14) EMERGENCY TRIAGE, TREAT, AND TRANSPORT (ET3) MODEL: Final Evaluation Report.
Feature picture: Ambulance bay of a Baltimore hospital with AMR, Baltimore County Fire, Baltimore City Fire, and Hatzalah community ambulances. https://www.maryland-traumanet.com/