EMS Related Education and Links

Emergency Responder Safety Tips - Central Wisconsin Electric Cooperative

Emergency Responder Safety Training Free Online Course - Alliant Energy

Energy Emergencies and First Responders - We Energies

Community Education - Epilepsy Foundation Heart of Wisconsin

Approaching Alzheimer's: First Responder Training - Alzheimer's Association

Autism Training for First Responders - Austim Risk & Safety Management

Trauma and PTSD Support Groups in Wisconsin

First Responder Training - Madison Gas & Electric

EMS Facts and Figures

There are 834 WI Ambulance Services (as of 10/01/2018).
The term 'Dispatcher' is no longer appropriate when referring to the person who does dispatching. The proper term is 'Telecommunicator'.

EMS Today Explained

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. 

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.

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EMS History

“Accidental Death and Disability: the Neglected Diseases of Modern Society”

While emergency medical care in one form or another has been around for perhaps hundreds of years, it was not until the early 1970s that EMS, in the form that we know it today, began to take shape. Prior to that time, EMS was provided by nearly anyone who would take on the task regardless of their training or experience.

Funeral homes often provided patient transport with little or no medical care being administered. Sometimes it was the local police department that provided medical care. Often, the local fire department would “rescue” a patient from a car accident or other trauma and then convey them to the hospital. Medical doctors made house calls for many of the same situations that EMS commonly responds to today.

While providers did the best that they could with what little training and support they had, in most cases, ambulances were inappropriately designed, ill-equipped, and staffed with inadequately trained personnel. One report found that at least 50% of the nation’s ambulance services were being provided by 12,000 morticians.

It was not until 1965 that the direction of EMS throughout the United States had the potential to improve. A publication of the National Academy of Sciences (NAS) titled “Accidental Death and Disability: the Neglected Diseases of Modern Society.” was released and began to receive attention.

That paper reported that in 1965, 52 million accidental injuries killed 107,000 Americans, temporarily disabled more than 10 million and permanently impaired 400,000 more at a cost of approximately $18 billion. Accidental injury is “the neglected epidemic of modern society” and “the nation’s most important environmental health problem,” the paper concluded.

Suggested Solutions

The NAS recommended several solutions, including the establishment of standards for ambulance design and construction, emergency medical equipment and supplies, and training and supervision of ambulance personnel. Congress responded to the NAS paper by enacting the National Highway Safety Act of 1966, which mandated the newly formed Department of Transportation (DOT) to establish minimum standards for the provision of care for accident victims. It also empowered DOT to penalize states up to 10% of their federal highway funds if they did not comply with the standards.

With the requirement to create an EMS system, and with Federal funding to help meet this goal, Wisconsin, like many states, began working towards implementation of ambulance services.

This included drafting legislation, creating and adopting training a curriculum, and the creation of a state EMS office. In 1969, the first nationally recognized training course for EMTs was held in Wausau, Wisconsin as a test site for the new DOT curriculum. The physician coordinator, Joseph D. ‘Deke’ Farrington was an EMS pioneer from Minocqua. Among his accomplishments, he promoted the use of extrication, invented the spine board and was responsible for the original 81 hour curriculum that Wisconsin and other states used. He also encouraged many other physicians to become involved in EMS.

Before Wisconsin and the nation could unveil EMS programs of their own, in 1971, the television program “Emergency!” appeared, catching the attention of the country. The program suggested to the public that paramedics existed everywhere. In reality, they did not. Additionally, it portrayed paramedics as frequent lifesavers when they were part of an integrated EMS system. In reality, they did save lives, though not as often as the television show led views to believe. Still “Johnny Gage and Roy DeSoto” came into America’s living rooms every Saturday night to provide a first hand look at what EMS was all about. The television show is credited with helping many areas of the country create new EMS programs in their local communities.

Training and Funding

While the training was now available, there was still no state requirements for anyone to receive it. Many fire departments and newly formed ambulance services began voluntarily taking the training on their own. However it took nearly five more years until 1974 before Wisconsin mandated training and required state approval to provide ambulance transport and EMS care. Requirements also went into place mandating that EMS care and ambulance transport be available in every Wisconsin township.

By this time, Wisconsin had licensed approximately 4,500 EMTs. While most EMTs and ambulance services were trained and authorized to provide Basic Life Support (BLS) care, several large cities began working toward creating paramedic programs that would include the administration of medications and the delivery of advanced procedures. Within a short time, communities including Janesville, West Allis, Milwaukee and Madison were providing paramedic Advanced Life Support (ALS).

Throughout the remainder of the 1970’s more ambulance services were created and additional EMTs were trained. During this time, over $500 million in funding was provided throughout the United States. Many of Wisconsin’s EMS services were created using this funding.

Funding under the EMS Systems Act essentially ended with the Omnibus Budget Reconciliation Act of 1981 which consolidated EMS funding into state preventive health and health services block grants. It was at this time, in the early 1980s that states gained greater discretion in funding statewide EMS activities and regional EMS systems, and many of the regional EMS management entities established by federal funding quickly dissolved.

Progression and Growth

As EMS continued to progress, local and regional EMS services began working on their own to make improvements in their level of care. State and national publications, conventions and organizations were solidly in place and helping to push EMS along as a component of the healthcare team. In 1985, the National Research Council’s report entitled Injury in America: A Continuing Public Health Problemdescribed deficiencies in the progress of addressing the problem of accidental death and disability.

Development of trauma care systems became a renewed focus of attention with passage of the Trauma Care Systems Planning and Development Act of 1990. The concept of a trauma system is to address the needs of all injured patients and match them to the available resources. The act encouraged the establishment of inclusive trauma systems and called for the development of a model trauma care system plan, which was completed nationally in 1992. In 1999, Wisconsin passed its own trauma legislation, a work in progress that continues through today.

The National Highway Traffic Safety Administration (NHTSA) implemented a statewide EMS technical assessment program in 1988. During assessments, statewide EMS systems are evaluated based on 10 essential components including: Regulation and policy; Resource management; Human resources and training; Transportation; Facilities; Communications; Public information and education; Medical direction; Trauma systems and; Evaluation.

NHTSA Evaluation of Wisconsin

In 1992, NHTSA came to Wisconsin to complete an evaluation. The resulting poor scores in many of the areas resulted in legislation being passed during the Wisconsin 1993-1994 legislative session in an effort to address these concerns.

The legislation created a governor-appointed statewide EMS Advisory Board, a Physician Advisory Committee and the creation of a state EMS Medical Director. It also required that multiple reports be created in an effort to address the NHTSA elements that had found to be lacking. The appointed groups also worked on various improvements to the EMS system including additions and innovations that had not been tried in other states.

During this time, additional skills, new medications, added training, quality assurance and data collection were all added for use throughout Wisconsin. It has been these elements and many others that have placed Wisconsin EMS beyond many other states in the country.

In 2001, NHTSA returned to conduct another assessment similar to the one completed nearly 10 years earlier. While they found vast improvement in many areas, they also found that many of the same problems that existed in 1992 were still in place in 2001.

Assessment teams from NHTSA have returned to Wisconsin to conduct reviews and provide reports several times since the first report in 1992, with the most recent occurring in 2012.

A Continued Work in Progress

As a relative new-comer when compared to other emergency services such as fire or police, EMS has traveled a long way in a relatively short period of time. EMS today is still very much a work in progress. Changes continue to be made on almost a yearly basis, designed to improve the care that is provided and the quality of EMS delivered throughout Wisconsin.

At any given time, there are multiple projects underway that may serve to improve and enhance Wisconsin EMS. While many of those first EMS providers in the early 1970’s are no longer involved, there are others who still continue to provide emergency medical services through this day. Indeed, EMS history can still often be provided directly by those same individuals who were there when it all began.

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Wisconsin EMS Statistics

As is the case in many states, the collection and analysis of EMS data is still very much a work in progress. Much of what is known is obtained through a variety of sources including directly from individual EMS organizations themselves. Still, the data that is available serves to provide an accurate snapshot of how Wisconsin EMS is set up and functions. It also provides us with a look at some of the data that is currently available.

The following questions and their answers will help you develop an accurate picture of EMS operations, data and statistics throughout Wisconsin.

1. How many ambulance services and EMTs are there in Wisconsin?
As of January 2017, there are approximately 425 total ambulance services in Wisconsin who respond to emergency (911) calls and/or provide training, interfacility transfers, intercepts, or are satellite stations of other ambulance providers. In addition, there are currently 11 air medical providers (helicopters) in Wisconsin and 325 certified First Responder services – also known as Emergency Medical Responders (EMR). This brings the total to approximately 750 licensed or certified EMS organizations or services in Wisconsin.  There are approximately 17,000 licensed EMS personnel; 2,900 certified First Responders, 7,300 EMT-Basics, 2,200 Intermediate Technicians – also known as Advanced EMTs (AEMT), 100 EMT-Intermediates, and 4,500 Paramedics.

LevelLicensed EMS Personnel
Basic 7,300
Intermediate Technician - AEMT 2,200
Intermediate 100
Paramedic 4,500
First Responder 2,900

2. How many ambulance calls occur in Wisconsin each year?
For the year 2011, there were 629,537 ambulance runs in Wisconsin. The number of runs entered into the state reporting system increased to 656,278 in 2012. In 2013 677,471 runs were reported. By 2014, the total number had peaked at 704,759. The run total fell to 646,289 in 2015.

Total Number of Ambulance Runs

Annual Ambulance RunsTotal Runs
2011 629,537
2012 656,278
2013 677,471
2014 704,759
2015 646,289

3. Does the local fire department also usually provide ambulance service to the community?
While it is a common belief that the local fire department also provides ambulance services, in Wisconsin, 43% of 911 responding ambulance services are provided by the fire department while 57% are separate and apart from the fire department. Fire department ambulance vehicles transport approximately 45% of patients each year while 55% are transported by non-fire-based ambulance providers.

OwnerWisconsin Ambulance Services
Municipality 64
Private Non-Profit 26
Private For-Profit 10

4. Who owns and operates Wisconsin’s ambulance services?
Approximately two-thirds of Wisconsin ambulance providers (64%) are owned and operated by a local municipality. Twenty-six percent (26%) are owned by a private, non-profit organization. The remaining 10% are for-profit ambulance services in the business of providing ambulance transport. Regardless of ownership, slightly over half of Wisconsin’s ambulance providers are stand alone or “third service” organizations not affiliated with a fire department or hospital. Volunteer fire departments represent 19% followed by full-time, paid fire departments at 13%. Hospitals provide ambulance service in 9.5% of cases. County-run ambulance services represent the remaining 5.5% of Wisconsin providers.

5. Who responds to the most ambulance emergency calls or provides the largest amount of EMS service in the state?
Wisconsin’s largest services also represent the largest amount of activity. In recent years, approximately 40% of all the calls that take place annually in Wisconsin are responded to by only 10 EMS services: Milwaukee Fire Department, Bell Ambulance, Paratech Ambulance, MedaCare Ambulance, Madison Fire Department, Curtis Ambulance, Gold Cross Ambulance of the Fox Valley, Tri-State Ambulance, Kenosha Fire Department and Racine Fire Department. Four out of five (80%) of Wisconsin’s ambulance services respond to less than 1,000 calls each year. More than half of Wisconsin’s ambulance services respond to under 400 calls each year. Nearly 40% of Wisconsin’s ambulance services respond to 200 or less runs in one year.

6. What percentage of EMS is provided by volunteers?
Defining a volunteer as someone who earns less than $2,500 a year for their EMS involvement (often less than $1,500 each year), volunteer and paid-on-call or paid-per-call EMS providers are responsible for staffing nearly 75% of Wisconsin’s ambulance services. However, they are responsible for responding to only 25% of Wisconsin’s EMS calls. The majority of ambulance transports are provided by full-time, paid ambulance services and fire departments. While definitive data is difficult to obtain, true volunteers where the EMS provider receives “nothing of financial value” for their EMS involvement is believed to be around 50%.

7. At what point do communities typically consider hiring full-time EMTs and Paramedics?
It is rare to find full-time, paid, fire departments or ambulance services with an annual call volume below 750, although, over the past 20 years, the number of such agencies has increased. Historically when a community’s annual run volume meets or exceeds 1,000 annual 911 calls is when the ambulance service begins to consider and find it necessary to hire full time EMTs and Paramedics.

8. How many care levels of ambulance services are there in Wisconsin and how many operate at each level?
Of the different levels of ambulance services provided in Wisconsin (EMT-Basic, EMT-Intermediate Technician or AEMT, EMT-Intermediate, EMT-Paramedic), 129 (30.5%) are licensed at the EMT-Basic level. A total of 133 (31.5%) are licensed at the Intermediate Technician level. There are 150 (35.5%) at the Paramedic level, and 10 (2.5%) at the EMT-Intermediate level. In addition, there are 323 groups certified at the Emergency Medical Responder level. First Responder groups do not transport patients but are a vital component of the EMS System and can provide early interventions, including CPR, first aid, defibrillation, several medications and stabilizing care.

LevelLicensed EMS Providers
Basic 129
Intermediate Technician 133
Intermediate 10
Paramedic 150

9. What are the reasons that people call for an ambulance?
Citizens call 911 to request an ambulance for a large number of reasons. Statistically, the most common reason is for trauma. The trauma can be a result of an automobile crash, a fall, an industrial accident, a sports injury, a physical assault, or many other reasons. A chief complaint of respiratory distress ranks second followed by complaints of chest pain. The list, in order of most common, continues with abdominal pain, altered level of consciousness, stroke, fainting, seizures, diabetic problems, cardiac arrest, and others.

ReasonChief Complaint
Trauma 25.4
Respiratory Distress 9.5
Chest Pain 8
Abdominal Pain 5.5
Altered LOC 4.5
Stroke 3.7
Seizure 3.5
Cardiac Rhythm Disturbance 3.3
Diabetic 3.2
Cardiac Arrest 2.4
Intoxication 2.3
Psychiatric Disorder 2.2
Headache 1.6
Hyperthermia 1.5
GI Bleed 1

10. How old are the people that require ambulance care and transport?
As with other types of health care, the elderly often require an ambulance more often than younger adults or children. In previous state surveys of run data, 45% of patients were found to be 65 years old or older. Age groups of 19 to 34, 35 to 49, and 50 to 64 each represented approximately 14% of patients. Only 5% of calls were for children age 12 and under, including newborns.

11. What percentage of calls are life threatening? What percentage require advanced levels of care?
While an emergency is often defined as a traumatic event or medical condition that the patient or others at the scene deem to be an emergency, not all ambulance calls are life threatening. Most ambulance services report that approximately half of their calls involve non-life-threatening conditions requiring only Basic Life Support (BLS) care. The remaining 50% require some form of advanced care (ALS), although the additional care may only include starting an IV on the patient. Approximately 20% of calls require the administration of one or more medications to the patient. Most ambulance services report that less than 10% of their calls are true life and death situations. Even so, a patient with a broken leg who cannot walk requires transport in an ambulance just as much as the patient who is unconscious or not breathing. However, a broken leg is rarely considered to be a life-threatening event.

12. How many EMTs and ambulance services in Wisconsin can start IVs and administer medications?
The number of Wisconsin ambulance services able to establish an IV and administer medications has more than doubled in the 25 year period from 1992 through 2017. Currently 69% of Wisconsin ambulance services (293) are trained and authorized to start IVs and administer eight or more medications. In 1992 only 29% of Wisconsin ambulance providers had this training and authorization while in 2002 46% provided these services.

13. How often is an EMT-Paramedic or EMT-Intermediate available to provide advanced level care?
It is estimated that nearly 85% of ambulance calls in Wisconsin have Advanced Cardiac Life Support (ACLS) medications, narcotic medications and multiple advanced procedures available to the patient or have agreements in place to call another ambulance service for an intercept to provide this advanced care to the patient when needed. These services are provided by the 40% of Wisconsin’s ambulance services operating at the EMT-Intermediate or EMT-Paramedic level.

14. Are volunteers sometimes paid, and if so, how much?
Previous, repeated surveys from the Wisconsin EMS Association and others has shown that EMTs who are paid when they respond on a call earn between $12.59 and $14.10 an hour, on average. Most ambulance services do not pay anything to their volunteers while they are “on call” waiting for a request for service to come in. Those who do pay their EMTs to be “on call” pay an overall average of $1.30/hour. The majority of “volunteer EMTs” who receive some amount of pay claim they earn $1,500 or less each year from their EMS involvement. It is rare for volunteer/paid-on-call EMS providers to earn more than $2,500 in any given year.

15. How often is an ambulance involved in a motor vehicle crash in Wisconsin?
Vehicle crashes involving an ambulance are a rare occurrence in Wisconsin. According to the Wisconsin Department of Transportation (DOT) there are an average of 15 crashes each year involving an ambulance. That figure represents 0.01% of all motor vehicle crashes in the state. An average of five ambulance crashes each year involve injuries. During the ten year period 1997-2006 there were a total of four fatal crashes involving an ambulance in Wisconsin.

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