What Is EMS? A Brief Guide to Emergency Medical Services

Emergency Medical Services—EMS, for short—is a branch of healthcare, public health, and public safety that responds to calls for help, 24/7, in almost every community in our nation. EMS encompasses a number of different services and roles, providing vital lifesaving care for patients during times of emergency. There are around 1.05 million licensed EMS professionals across the U.S. and nearly 623,000 of these are EMTs, while over 268,000 are paramedics. 

According to the National Association of Emergency Medical Technicians (NAEMT):

“EMS saves lives from heart attacks and strokes; treats injuries due to motor vehicle collisions, shootings, stabbings and other violence; and provides care for the many other illnesses and injuries that occur daily in the United States. In addition, EMS provides care for chronic illnesses and preventive care through community paramedicine and mobile integrated healthcare programs. 

When communities are destabilized during mass casualty incidents – whether natural disasters (tornadoes, floods, hurricanes, pandemics) or man-made (terrorist attacks, explosions, active shooters) – EMS is the community lifeline that renders medical care and comforts the sick and frightened. As the COVID-19 pandemic has demonstrated, EMS practitioners serve as front-line medical responders during public health crises.”

In order to offer more clarity around the definition, roles, responsibilities, and services of EMS, NAEMT recently published a brief introduction to EMS. In What Is EMS?, NAEMT explores the range of services that EMS provides to your community, from 911 and disaster response to community paramedicine; the basics of how EMS operates, including staffing, delivery, and regulations; and how EMS is reimbursed for their services (which may surprise you).

Read on for some of the highlights, or check out the full guide here. 

DID YOU KNOW?

• EMS is regulated by state law. When a member of the public calls 911 for help, laws in every state require EMS to respond. EMS is also obligated to take that person to an emergency department if the person wishes to go. EMS laws in many states prohibit EMS from taking patients to any facility other than the hospital. However, these rules were relaxed during the COVID-19 public health emergency.
• The difference between paramedics and EMTs? Their level of education. EMTs have about 150 to 260 hours of initial education, while paramedics are required to have a minimum of 1,500 hours, often through a two-year college program.

• Paramedics often start their careers as EMTs. After gaining on-the-job experience, they may go on to complete additional education requirements to become a paramedic. Paramedics can also undergo additional training to earn specialty certifications, such as flight paramedic, critical care paramedic, or community paramedic.
• EMS agencies can be staffed by paid professionals, volunteers, or a combination. Many volunteer EMS agencies struggle to find enough volunteers to meet community needs, so some ambulance services combine both volunteer and paid staff.
• EMS can be provided by public agencies or private companies. Local governments can contract with a hospital-based EMS service to provide 911 medical response for a region. There’s also an EMS model called public utility, which is a hybrid model involving both a public entity and a private, nonprofit company.
• To better serve communities and patients, EMS agencies in over 30 states offer programs known as community paramedicine or mobile integrated healthcare. Through these programs, EMS partners with other healthcare or social services organizations to provide services such as:
  
  
  • Home visits to assist patients with chronic disease management or post-hospital discharge follow-up.
  • Transporting patients to “alternative destinations” best suited to meet their needs, such as  mental health clinics or substance abuse treatment centers.
  • Connecting patients with social services and other community-based services to ensure they have basic needs met (such as food and having prescriptions filled).
  • Providing a nurse advice line for people who call 911 for non-urgent matters, instead of dispatching an ambulance crew.
  • Using telemedicine to connect patients in their home with physicians at other locations.
  • Providing treatment in place for some COVID-19 patients, to conserve resources (such as ambulances, PPE, and hospital beds), and avoid costly hospital visits for patients who can be cared for safely at home.

• EMS is often ONLY reimbursed for transporting patients—not treating them. Even if EMS saves your life, they are technically only paid for driving you to the hospital. Generally, if EMS provides care on scene but does not transport a patient to the hospital, they don’t receive reimbursement for providing medical attention. In 2018, over 11 million EMS responses went uncompensated.

• The problem with this model became evident during the COVID-19 pandemic, as EMS agencies were encouraged to treat patients who didn’t need to go to the hospital at home. But as medics risked their lives to respond to calls and provide treatment to COVID-positive patients, they weren’t compensated for any of it.
• Throughout the pandemic, EMS has consistently proven how invaluable their services are. EMTs and paramedics have consistently risked their own safety to serve COVID-19 patients, providing breathing treatments and other supportive care in patients' homes. They've also stepped up to serve as contact tracers and to conduct COVID-19 testing, and have helped to fill labor shortages in nursing homes, emergency departments, even working as school nurses. And when vaccines are released, EMS professionals are ready to help, as they have the qualifications needed to help with mass immunizations.
  
  

To learn more about the range of services EMS provides to the community, the basics of EMS operations, and how reimbursement affects the EMS workforce—and ultimately, patients and communities—download What Is EMS?

To learn about how EMS leaders are using cutting edge technology to help treat patients in place during the COVID-19 pandemic, check out 911-Initiated Telemedicine: How Clinical Leaders are Using Mobile Tech.