Emergency Medical Services (EMS) and Community Paramedicine

Policy Resources

High-quality, accessible emergency medical services (EMS) provided to patients experiencing time-sensitive emergencies, including stroke, myocardial infarction, and cardiac arrest, can substantially improve survival rates and promote optimal recovery.^1,2

However, the quality and accessibility of EMS vary widely across the United States, in part because EMS programs are largely funded by state and local governments, leading to variations in the structure and organization of service delivery.^3,4

Research has also identified substantial differences in health outcomes associated with race and ethnicity, gender, and geography (particularly for rural and low-income communities).^5,6,7,8

Community paramedicine is an emerging approach that can help address health inequities. Community paramedics work in nontraditional ways to expand access and reduce barriers to primary and preventive care for underserved populations.⁹

Learn more about the evidence related to EMS and community paramedicine and where evidence-informed policies have been adopted and implemented in the United States.

Emergency Medical Services Home Rule State Law Fact Sheet

This state law fact sheet (SLFS) provides a five-state analysis of local government autonomy and local funding mechanisms in effect as of January 31, 2022. Policy and public health professionals and researchers can use this to understand local government challenges of providing life-saving EMS.

Kleindorfer DO, Lindsell CJ, Broderick JP, Flaherty ML, Woo D, Ewing I, et al. Community socioeconomic status and prehospital times in acute stroke and transient ischemic attack: do poorer patients have longer delays from 911 call to the emergency department? Stroke. 2006;37(6):1508–13.
Saczynski JS, Yarzebski J, Lessard D, Spencer FA, Gurwitz JH, Gore JM, Goldberg RJ. Trends in prehospital delay in patients with acute myocardial infarction (from the Worcester Heart Attack Study). Am J Cardiol. 2008 Dec 15;102(12):1589–94.
MacKenzie EJ, Carlini AR. Characterizing local EMS systems. Report no. DOT HS 811 824. National Highway Traffic Safety Administration; August 1, 2013.
Institute of Medicine. Emergency Medical Services: At the Crossroads. National Academies Press; 2007.
Ashburn NP, Snavely AC, Angi RM, Scheidler JF, Crowe RP, McGinnis HD, Hiestand BC, Miller CD, Mahler SA, Stopyra JP. Prehospital time for patients with acute cardiac complaints: A rural health disparity. Am J Emerg Med. 2022 Feb;52:64–68.
Ashburn NP, Snavely AC, Angi RM, Scheidler JF, Crowe RP, McGinnis HD, et alHiestand BC, Miller CD, Mahler SA, Stopyra JP. Prehospital time for patients with acute cardiac complaints: aA rural health disparity. Am J Emerg Med. 2022 Feb;52:64–68.
Schwartz J, Dreyer RP, Murugiah K, Ranasinghe I. Contemporary prehospital emergency medical services response times for suspected stroke in the United States. Prehosp Emerg Care. September–October 2016;20(5):560–5.
Roberson S, Dutton M, Macdonald M, Odoi A. Does place of residence or time of year affect the risk of stroke hospitalization and death? A descriptive spatial and temporal epidemiologic study. PLOS ONE. 2016;11(1):e0145224.
Rural Community Paramedicine Toolkit. Rural Health Information Hub. Accessed July 16, 2020.