Annals of Emergency Medicine
Volume 49, Issue 3 , Pages 304-313 , March 2007

A Comprehensive Framework for Determining the Cost of an Emergency Medical Services System

  • E. Brooke Lerner, PhD

      Affiliations

    • Department of Emergency Medicine and Department of Community and Preventive Medicine, University of Rochester, Rochester, NY (Lerner)
    • Department of Emergency Medicine at the Medical College of Wisconsin, Milwaukee, WI
    • Corresponding Author InformationAddress for correspondence: E. Brooke Lerner, PhD, Department of Emergency Medicine, Medical College of Wisconsin, Froedtert Hospital, 9200 W. Wisconsin Ave, Milwaukee, WI 53226; 414-805-0113, fax 414-805-6464
    • ,
  • Graham Nichol, MD, MPH

      Affiliations

    • University of Washington–Harborview Center for Prehospital Emergency Care and Emergency Services, Harborview Medical Center, University of Washington, Seattle, WA (Nichol)
    • ,
  • Daniel W. Spaite, MD

      Affiliations

    • Arizona Emergency Medicine Research Center, Department of Emergency Medicine, College of Medicine, University of Arizona, Tucson, AZ (Spaite)
    • ,
  • Herbert G. Garrison, MD, MPH

      Affiliations

    • Department of Emergency Medicine, East Carolina University, Greenville, NC (Garrison)
    • ,
  • Ronald F. Maio, DO, MS

      Affiliations

    • Department of Emergency Medicine, University of Michigan, Ann Arbor, MI (Maio)

Received 31 May 2006 ,Revised 21 September 2006 ,Accepted 22 September 2006.

References 

  1. Committee on the Future of Emergency Care in the United States Health System Board on Health Care Services. Emergency Medical Services at the Crossroads. Washington, DC: National Academies Press; 2006;
  2. Callaham M. Quantifying the scanty science of prehospital emergency care. Ann Emerg Med. 1997;30:785–790
  3. Koenig KL. Quo vadis: “scoop and run,” “stay and treat,” or “treat and street”?. Acad Emerg Med. 1995;2:477–479
  4. Koenig KL. Unscheduled access to health care: reengineering the 911 system. Acad Emerg Med. 1996;3:989–991
  5. Reines HD, Bartlett RL, Chudy NE, et al. Is advanced life support appropriate for victims of motor vehicle accidents: the South Carolina Highway Trauma Project. J Trauma. 1988;28:563–570
  6. Smith JP, Bodai BI, Hill AS, et al. Prehospital stabilization of critically injured patients: a failed concept. J Trauma. 1985;25:65–70
  7. Spaite DW, Criss EA, Valenzuela TD, et al. Emergency medical service systems research: problems of the past, challenges of the future. Ann Emerg Med. 1995;26:146–152
  8. Seidel JS, Henderson D, Tittle S, et al. Priorities for research in emergency medical services for children: results of a consensus conference. Pediatr Emerg Care. 1999;15:55–58
  9. Spaite DW, Criss EA, Valenzuela TD, et al. Developing a foundation for the evaluation of expanded-scope EMS: a window of opportunity that cannot be ignored. Ann Emerg Med. 1997;30:791–796
  10. Stiell IG, Wells GA, Spaite DW, et al. The Ontario Prehospital Advanced Life Support (OPALS) Study part II: rationale and methodology for trauma and respiratory distress patients: OPALS Study Group. Ann Emerg Med. 1999;34:256–262
  11. O'Connor RE, Cone DC, De Lorenzo RA, et al. EMS systems: foundations for the future. Acad Emerg Med. 1999;6:46–53
  12. Raskin IE, Maklan CW. Medical treatment effectiveness research: a view from inside the Agency for Health Care Policy and Research. Eval Health Prof. 1991;14:161–186
  13. Relman AS. Assessment and accountability: the third revolution in medical care. N Engl J Med. 1988;319:1220–1222
  14. Roper WL, Winkenwerder W, Hackbarth GM, et al. Effectiveness in health care: an initiative to evaluate and improve medical practice. N Engl J Med. 1988;319:1197–1202
  15. Delbridge TR, Bailey B, Chew JL, et al. EMS agenda for the future: where we are … where we want to be: EMS Agenda for the Future Steering Committee. Ann Emerg Med. 1998;31:251–263
  16. Brice JH, Garrison HG, Evans AT. Study design and outcomes in out-of-hospital emergency medicine research: a ten-year analysis. Prehosp Emerg Care. 2000;4:144–150
  17. Spaite DW. Outcome analysis in EMS systems. Ann Emerg Med. 1993;22:1310–1311
  18. Valenzuela TD, Spaite DW, Meislin HW, et al. Case and survival definitions in out-of-hospital cardiac arrest: effect on survival rate calculation. JAMA. 1992;267:272–274
  19. Valenzuela TD, Roe DJ, Nichol G, et al. Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos. N Engl J Med. 2000;343:1206–1209
  20. Zheng ZJ, Croft JB, Giles WH, et al. Sudden cardiac death in the United States, 1989 to 1998. Circulation. 2001;104:2158–2163
  21. Eisenberg MS, Horwood BT, Cummins RO, et al. Cardiac arrest and resuscitation: a tale of 29 cities. Ann Emerg Med. 1990;19:179–186
  22. Nichol G, Stiell IG, Laupacis A, et al. A cumulative meta-analysis of the effectiveness of defibrillator-capable emergency medical services for victims of out-of-hospital cardiac arrest. Ann Emerg Med. 1999;34:517–525
  23. Cummins RO, Ornato JP, Thies WH, et al. Improving survival from sudden cardiac arrest: the “chain of survival” concept: a statement for health professionals from the Advanced Cardiac Life Support Subcommittee and the Emergency Cardiac Care Committee, American Heart Association. Circulation. 1991;83:1832–1847
  24. Bass RR, Gainer PS, Carlini AR. Update on trauma system development in the United States. J Trauma. 1999;47(3 suppl):S15–S21
  25. Mann NC, Mullins RJ, MacKenzie EJ, et al. Systematic review of published evidence regarding trauma system effectiveness. J Trauma. 1999;47(3 suppl):S25–S33
  26. MacKenzie EJ. Review of evidence regarding trauma system effectiveness resulting from panel studies. J Trauma. 1999;47(3 suppl):S34–S41
  27. Jurkovich GJ, Mock C. Systematic review of trauma system effectiveness based on registry comparisons. J Trauma. 1999;47(3 suppl):S46–S55
  28. Mann NC. Assessing the effectiveness and optimal structure of trauma systems: a consensus among experts. J Trauma. 1999;47(3 suppl):S69–S74
  29. Mann NC, Mullins RJ. Research recommendations and proposed action items to facilitate trauma system implementation and evaluation. J Trauma. 1999;47(3 suppl):S75–S78
  30. Spaite DW, Criss EA, Valenzuela TD, et al. Prehospital advanced life support for major trauma: critical need for clinical trials. Ann Emerg Med. 1998;32:480–489
  31. Lerner EB, Maio RF, Garrison HG, et al. Economic value of prehospital emergency care: a structured literature review. Ann Emerg Med. 2006;47:515–524
  32. Gold MR, Siegel JE, Russell LB. Cost-effectiveness in Health and Medicine. New York, NY: Oxford University Press; 1996;
  33. American Ambulance Association. Community Guide to Ensure High Performance Emergency Ambulance Service. McLean, VA: American Ambulance Association; 2004;
  34. Sloan F. Valuing Health Care. New York, NY: Cambridge University Press; 1995;
  35. O'Brien DJ, Price TG, Adams P. The effectiveness of lights and siren use during ambulance transport by paramedics. Prehosp Emerg Care. 1999;3:127–130
  36. Brouwer WB, Koopmanshcap MA, Rutten FF. Response to recommendation of the Washington Panel. Health Econ. 1997;6:253–259
  37. Johannesson M, Karlsson G. The friction cost method: a comment. J Health Econ. 1997;16:249–255
  38. Koopmanschap MA, Rutten FF, van Ineveld BM, et al. The friction cost method for measuring indirect costs of disease. J Health Econ. 1995;14:171–189
  39. Finkler SA. The distinction between cost and charges. Ann Intern Med. 1982;96:102–109
  40. Maio RF, Garrison HG, Spaite DW, et al. Emergency Medical Services Outcomes Project I (EMSOP I): prioritizing conditions for outcomes research. Ann Emerg Med. 1999;33:423–432
  41. Spaite DW, Maio R, Garrison HG, et al. Emergency Medical Services Outcomes Project (EMSOP) II: developing the foundation and conceptual models for out-of-hospital outcomes research. Ann Emerg Med. 2001;37:657–663
  42. Maio RF, Garrison HG, Spaite DW, et al. Emergency Medical Services Outcomes Project (EMSOP) IV: pain measurement in out-of-hospital outcomes research. Ann Emerg Med. 2002;40:172–179
  43. Keim SM, Spaite DW, Maio RF, et al. Risk adjustment and outcome measures for out-of-hospital respiratory distress. Acad Emerg Med. 2004;11:1074–1081
  44. Garrison HG, Maio RF, Spaite DW, et al. Emergency Medical Services Outcomes Project III (EMSOP III): the role of risk adjustment in out-of-hospital outcomes research. Ann Emerg Med. 2002;40:79–88
  45. Becker LB, Han BH, Meyer PM, et al. Racial differences in the incidence of cardiac arrest and subsequent survival: the CPR Chicago Project. N Engl J Med. 1993;329:600–606
  46. Iwashyna TJ, Christakis NA, Becker LB. Neighborhoods matter: a population-based study of provision of cardiopulmonary resuscitation. Ann Emerg Med. 1999;34:459–468
  47. Sampson RJ, Morenoff JD, Raudenbush S. Social anatomy of racial and ethnic disparities in violence. Am J Public Health. 2005;95:224–232
  48. Sampson RJ, Raudenbush SW, Earls F. Neighborhoods and violent crime: a multilevel study of collective efficacy. Science. 1997;277:918–924
  49. Dunn L, Henry J, Beard D. Social deprivation and adult head injury: a national study. J Neurol Neurosurg Psychiatry. 2003;74:1060–1064
  50. Cubbin C, LeClere FB, Smith GS. Socioeconomic status and the occurrence of fatal and nonfatal injury in the United States. Am J Public Health. 2000;90:70–77
  51. Cubbin C, LeClere FB, Smith GS. Socioeconomic status and injury mortality: individual and neighbourhood determinants. J Epidemiol Community Health. 2000;54:517–524
  52. Singh GK, Siahpush M. Increasing inequalities in all-cause and cardiovascular mortality among US adults aged 25-64 years by area socioeconomic status, 1969-1998. Int J Epidemiol. 2002;31:600–613
  53. Wilkins R, Berthelot J-M, Ng E. Trends in mortality by neighbourhood income in urban Canada from 1971 to 1996. Health Rep. 2002;13:45–72
  54. Razzak JA, Sasser SM, Kellermann AL. Injury prevention and other international public health initiatives. Emerg Med Clin North Am. 2005;23:85–98
  55. Health disparities experienced by black or African Americans: United States. MMWR Morb Mortal Wkly Rep. 2005;54:1–3

 Supervising editor: Donald M. Yealy, MD

 Funding and support: This work was funded by the National Highway Traffic Safety Administration through Cooperative Agreement DTNH22-98-H-05117 awarded to the National Association of State EMS Directors.

 Reprints not available from the authors.

PII: S0196-0644(06)02274-8

doi: 10.1016/j.annemergmed.2006.09.019

Annals of Emergency Medicine
Volume 49, Issue 3 , Pages 304-313 , March 2007

Article Tools

* Image Usage & Resolution