Approximately 4.5 million Americans live in what is known as an “ambulance desert,” meaning they are more than 25 minutes away from the nearest ambulance service.
Gaps in the provision of ambulance services are exacerbated in rural areas, which have larger geographic coverage areas, difficulty recruiting and retaining clinicians, and higher fixed costs like equipment and administrative costs.
States play an important role in ensuring the health and safety of the population through an integrated and coordinated health system, including emergency medical services. The organizational structure of EMS, including service providers and financing, varies significantly by state.
For example, EMS agencies, and their clinicians, may be volunteer, career or a combination. They may be operated by government (municipal, county, regional or state), health care systems or private entities. They may function as a stand-alone agency or in conjunction services aligned with fire or law enforcement. All of these characteristics contribute to a diverse and complicated EMS landscape.
While EMS systems often exist across health care, public health, public safety and emergency preparedness systems, health care is often the most reliable source of funding. State EMS systems often comprise of a mix of all of these agency types, and they may be coordinated at the municipal, county, regional or state level.
Several states ensure access to EMS by defining it as a service area and license EMS agencies to ensure a minimum level of care or require local entities to establish a plan for ensuring access to EMS.
What Is an "Essential Service"?
While essential services are generally understood to be a service the government is required to provide to its citizens, definitions of essential services and who is required to provide them vary greatly from state to state. Generally, states have the authority to determine which services are defined as “essential,” and what requirements exist in statute for such services.
According to the National Association of Public Administration, there is no reference to legal or policy definitions of essential service, and the term is not used consistently or defined, but “usage of the term in state statute is suggestive.” The association’s 2014 study refers to two Supreme Court decisions that address the question of what constitutes essential government functions: New York v. United States and National League of Cities v. Usery.
According to the Fordham University Urban Law Review, “The Supreme Court in National League of Cities vs. Usery turned to the general definition of an essential government function suggested in New York v. United States to determine whether federal or state governments ought to regulate local government employees. However, rather than delineating a working definition of an essential governmental function, the court merely stated several examples of activities considered to be essential.”
State legislation establishing EMS as an essential service vary greatly but may establish minimum requirements for EMS across the state, provide flexibility to organize and finance EMS at the local level or provide resources to support EMS system improvement.
At least 15 states and the District of Columbia have enacted legislation explicitly defining EMS as “essential” in statute, as shown in the map and table below.