Diversity of Emergency Medical Services
Emergency Medical Services (EMS) throughout Wisconsin is as diverse as the people who help to provide this valuable service. There is no single correct way to deliver EMS services and one model has not found to be inherently better than the others.
There are perhaps a dozen different categories of EMS providers operating throughout Wisconsin. There are fire departments who not only provide fire protection but also emergency medical transport. These can further be broken down into volunteers, paid-on-call and full-time fire departments.
There are private ambulance services, some of which operate as a for-profit business as well as others that are prohibited from making a profit by their non-profit status. There are ambulance services who are owned and operated by the local hospital.
There are services who are ran by the county, while there are others who are operated by a city or village but are separate and distinct from the city or village fire department. As you can see, there is no limit to the types of EMS providers throughout Wisconsin.
A Look at Ambulance Services
Today there are approximately 425 ambulance services that are authorized by the Wisconsin Department of Health and Family Services (DHFS) to treat and transport patients in Wisconsin. Approximately 375 of these services respond to emergency (911) calls. The remaining services provide a variety of additional services such as training new EMTs and Paramedics. Some ambulance services only transport patients from one facility, such as a nursing home, to another facility. This is known as interfacility transfers. Some services provide help or assistance to the local ambulance by sending paramedics or other highly trained individuals to provided advanced levels of care. This is called an intercept as the second vehicle often meets the original ambulance on the way to the hospital thereby “intercepting” the call.
When looking at all of services, the stand-alone, volunteer ambulance service is the category in which the largest number of providers are classified. In this case, while stand alone (no fire department involvement) volunteer ambulance services make up nearly 45% of providers, they are responsible for only 16% of Wisconsin’s EMS calls.
If we add volunteer fire departments to the mix of all the volunteer ambulance providers in Wisconsin, we come to a total of 24% of Wisconsin’s annual EMS calls. So while volunteers staff the largest number of ambulances in Wisconsin, they are responsible for less than a quarter of the patient transports completed each year.
Due to very large populations, nearly 40% all ambulance calls in Wisconsin are handled by about only a dozen ambulance services. The Milwaukee Fire Department is the largest, followed by Bell Ambulance, Paratech Ambulance, MedaCare Ambulance, Madison Fire Department, Curtis Ambulance, Gold Cross Ambulance of the Fox Valley, and severalothers.
Each of these ambulance services complete over 7,500 ambulance calls each year. At the opposite end of the scale, four out of five, or 80% of ambulance services, complete less than 1,000 calls each year and nearly 40% of all ambulance services in Wisconsin respond to 200 or fewer runs each year.
Pre-Hospital Care Providers
There are currently five distinct levels of pre-hospital care provided through the Wisconsin EMS system. It starts with the first responder or Emergency Medical Responder (EMRwho completes approximately 50 hours of training. These providers arrive to treat the patient prior to the arrival of an ambulance. They are not licensed to transport patients – only to treat them on the scene before turning them over to the ambulance crew. There are approximately 325 EMR organizations throughout Wisconsin – mostly in the more rural areas of the state where it may commonly take 15 to 30 minutes or more for an ambulance to arrive.
The minimum level of care offered by an ambulance service in Wisconsin is the EMT-Basic level. EMT-Basics have completed 180 hours of education and are licensed to transport patients in the ambulance. In 1992, 77% of all ambulance services were licensed at the EMT-Basic level. Today, only 29% operate at the basic level with the others having moved to a higher level of care.
The next level is the EMT-Intermediate Technician or Advanced EMT (AEMT). As of January 20017, there were a total of 133 ambulance services operating at this level. In addition to the 180 hours of training they received to become an EMT-Basic, AEMTs receive an additional 170 hours of classroom, lab and hospital/field training to be able to start IVs and administer a handful of medications.
The next level is the EMT-Intermediate. These EMTs have completed an additional 500 hours of education and are able to administer more than 20 different medications, including cardiac medications and narcotics, as well as perform a variety of advanced procedures. In many ways, today’s EMT-Intermediate compares very closely to the early paramedics of the 1970s and 1980s.
The top and final level of care is the EMT-Paramedic. Paramedics complete in excess of 1,000 hours of training to be able to administer a virtually limited number of medications and perform more advanced procedures than any other level of care.
As with other changes in EMS over the years, in 1992 only 9% of Wisconsin ambulance services operated at this level. Today, 35% of all ambulance services are licensed at the paramedic level. Currently, nearly 70% of Wisconsin ambulance services are trained and authorized to start IVs and administer eight or more medications to patients. In 1992, only 29% had this training and certification.
It is estimated that approximately 85% of ambulance calls in Wisconsin have Advanced Cardiac Life Support (ACLS) medications, narcotic medications, and multiple advanced procedures available to the patient by either an EMT-Intermediate or EMT-Paramedic service on the scene or available through an intercept. All of these calls are covered by only 35% of Wisconsin ambulance services. For more information on the various levels of care, be sure to review the EMS Education page.
Reasons for Ambulance Runs
Over 600,000 ambulance runs are completed each year in Wisconsin. This includes transports from one medical facility to another, to a nursing home and in some cases returning home. The most common reason for calling an ambulance is due to trauma, whether from a motor vehicle accident, a fall, or any other variety of injury causes. Chest pain accounts for the next most common ambulance call followed by difficulty breathing, abdominal pain, altered level of consciousness and stroke.
As with other components of our healthcare system, patients over the age of 64 account for the largest patient population with approximately 45% of patients falling into this category. Age groups of 19 to 34, 35 to 49, and 50 to 64 each represent approximately 14% of patients. Only 5% of ambulance calls are for children age 12 and under, including newborns.
Most ambulance services report that approximately 50% or more of their calls involve non-life-threatening conditions require only Basic Life Support (BLS) care. The remaining 50% require some form of advanced care, although the additional care may only including starting an IV on the patient.
Approximately 20% of ambulance calls require the administration of one or more medications. Most ambulance services report that only 10% of their calls are true life and death situations. Remember, a patient with a broken leg who cannot walk requires an ambulance just as much as the patient that is unconscious or not breathing. However, a broken leg is rarely a life-threatening event.
Staffing First Response Services
In order to staff the 425 ambulance services and 325 first responder agencies, there are over 14,000 licensed EMTs and approximately 3,000 first responders in Wisconsin. This number has remained mostly consistent throughout the past 25 years. This is because each year approximately 1,000 new EMTs obtain their license while another 1,000 discontinue their involvement in EMS and let their license lapse.