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. The information below is 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.
There are approximately 375 ambulance providers who respond to emergency (911) calls in Wisconsin. There are another 75 services that provide training, inter-facility transfers, intercepts, or are satellite stations of other ambulance providers. This brings the Wisconsin ambulance service total to approximately 450 EMS organizations or services.
Over 1.5 million ambulance transports are completed in Wisconsin each year, that is more than 4,100 transports per day in Wisconsin.
While it is a common belief that the local fire department also provides ambulance services, in Wisconsin, 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.
Wisconsin's largest services also represent the largest amount of activity. Approximately 40% of all the calls that take place each year 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% see 200 or less runs a year.
Volunteer 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.
It is rare to find full-time, paid, fire departments or ambulance services with an annual call volume below 750. Typically when annual run volumes meet or exceed 1,000 is when communities begin to consider hiring full time EMTs and Paramedics. In order to staff the 450 ambulance services and 200 first responder agencies, there are over 16,000 licensed EMTs and approximately 4,500 first responders in Wisconsin. This number has remained consistent throughout the past 15 years. Each year approximately 1,000 new EMTs obtain their license while another 1,000 discontinue their involvement in EMS and let their license lapse.
Of the four different levels of ambulance services provided in Wisconsin (EMT, Advanced EMT, EMT-Intermediate, EMT-Paramedic), 180 (41%) are licensed at the EMT (Basic level). A total of 130 (29%) are licensed at the Advanced EMT level. There are 120 (28%) at the Paramedic level, and 5 (2%) At the EMT-Intermediate level.
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. Chest pain ranks second followed by respiratory distress. The list, in order of most common, continues with abdominal pain, altered level of consciousness, stroke, fainting, seizures, diabetic problems, cardiac arrest, and others.
As with other types of health care, the elderly often require an ambulance more often than younger adults or children. In a previous state survey 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.
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 50% or more of their calls involve non-life-threatening conditions requiring only Basic Life Support (BLS) care. The remaining 50% require some form of advanced care, 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 only 10% of their calls are a 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.
Currently 60% of Wisconsin ambulance services are trained and authorized to start IVs and administer eight or more medications to patients. Fifteen years ago only 29% had this training and authorization.
It is estimated that approximately 85% of ambulance calls 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 30% of Wisconsin's ambulance services operating at the EMT-Intermediate or EMT-Paramedic level.
Multiple, repeat surveys from the Wisconsin EMS Association has shown that EMTs who are paid when they go on a call earn between $12.59 and $14.10 an hour, on average. Most ambulance services (approximately 70%) do not pay anything to their volunteers while they are "on call" waiting for a call to come in. The remaining 30% who do pay their EMTs to be "on call" pay an overall average of $1.30/hour. The majority of EMTs who receive some amount of pay claim they earn $1,500 or less each year from EMS. It is rare for volunteer/paid-on-call EMS providers to earn more than $2,500 in any given year.
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.
Ambulance services are generally supported by local municipalities through user fees or special assessments, these fees range from $4.00 to over $65.00 per capita in the population served, the average is about $36.00 in the state. Many also charge patient’s a fee for service to cover operating costs and assure continued service to the community. All of these fees depend on the type and level of service as well as total population served.
Information provided by Don Hunjadi and the Wisconsin EMS Association.
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