The Price of Saving Lives

"How much does it cost?"

Even EMS providers, where the goal is saving lives, can’t escape that question. The latest effort to determine the cost of EMS to the communities it serves is the EMS Cost Analysis Project (EMSCAP), a collaboration between the National Association of State EMS Officials (NASEMSO) and researchers E. Brooke Lerner, Graham Nichol, Daniel Spaite, Herbert Garrison and Ronald Maio.

EMSCAP is a continuation of the Emergency Medical Services Outcomes Project (EMSOP), a recently completed five-year National Highway Safety Administration (NHTSA) project intended to support and facilitate EMS outcomes research and evaluation. The objective of EMSCAP is to create a comprehensive framework that allows users to determine the cost of providing prehospital emergency care from a societal prospective.

The project goals are:

• To synthesize the state of the art/science of economic evaluation and its relevance to EMS research by completing a systematic review of literature in regard to EMS economic evaluation studies.
• To develop a conceptual framework for applying cost analysis in EMS research.
• To develop a cost workbook that could be used by communities to calculate the cost of EMS in their community.

This has been going on for a long time,” says Lerner, associate professor of emergency medicine at the Medical College of Wisconsin, Milwaukee, and the principal investigator for the project. “The study was originally released a couple of years ago, but the paper took longer. It will be [published] in Academic Emergency Medicine in February but the workbook and other information is currently available through the NASEMSO website.”

Lerner says so far the project has been well received by participants, particularly in the pilot communities of Oshkosh, WI, Richmond, VA, and Livingston County, NY. But the key is getting an EMS agency to buy in to the system.

Lerner’s doing her part to spread the word, having conducted a number of presentations at national meetings and getting reports on EMSCAP published in several trade newsletters, as well as Annals of Emergency Medicine. One of the things she tries to get across is that the workbook is free and anybody can access and use it.

For the pilot communities, a lot of work was done to help work out kinks in the system. So while they were able to collect usable data of their own, they did just as much work fine-tuning the workbook so other agencies could use it without any hiccups.

One of the most user-friendly aspects of the workbook is that it allows users to calculate costs to correspond with whatever their goal is. If your agency is considering purchasing a new piece of equipment, for example, the workbook allows users to do an extensive cost analysis to determine if the project is viable.

Because every EMS agency calculates its costs in different ways, Lerner says, the hope of researchers was the workbook would be the basis for a common language throughout EMS so cost evaluations could be standardized industry-wide.

Lerner says one of the most interesting things to come out of the study is the inherent cost of readiness.

“You can’t cost-effectively be open only when people want you,” Lerner explains. “You can’t schedule emergencies, so the controversy becomes who pays for the cost of readiness? Do you simply send a pick-up truck to the scene with first responders, or do you send a fire truck? There’s a big difference in cost when you use specialized apparatuses like fire trucks and the EMS community needs to start making some decisions based on strict rules of cost analysis.”

Lerner acknowledges it won’t always be easy to perform a cost analysis and achieve a desired outcome, particularly as the size of a community grows and different agencies need to be pulled into the fold. But it’s important to keep EMS research moving forward, with projects like the EMSCAP workbook, because costs only continue to rise.