Public utility model

There must be a governmental oversight agency which coordinates the provision of emergency medical services throughout the entire service area. These are usually boards made up of stakeholders in an EMS system (citizens, elected/appointed government officials, physicians, paramedics, nurses, financial gurus, and even consumer advocates)

High quality patient care is the number one focus of a public utility model EMS service. Continuous quality improvement is paramount, and every aspect of the EMS delivery process is examined and re-examined exhaustively in a never-ending cycle.

Services are provided by contractors who are under "performance-based" agreements. These type of arrangements require results be achieved using the creativity and innovative methods of the providers. There are performance benchmarks established for dispatchers, unit response times.

Financial controls must be in place where the public utility model oversight authority controls all EMS system funding. A public utility model is designed to be funded through the collection of user fees and not reliance on tax money. While some systems struggle with reimbursement issues, the fact remains that a substantial portion of PUM operating revenues are derived from user fees not tax subsidy.

Advanced Life Support (ALS) resources are sent to all calls - there may be a tiered response with a local fire department providing BLS first response via an engine or truck company, but the level of transporting care is always ALS and always at the paramedic level.

Purists will argue, with merit, that a true PUM must encompass all five of these hallmarks. However, many existing PUM operations are a hybrid of a simple third-service EMS organization utilizing one or more of the above listed characteristics in an effort to provide the best advanced life support patient care possible.

Ambulances are geographically deployed based on projected demand by the time of day and day of week by using historic demand data. This model responds to the fact that as populations move from home to work and back, geographic demand patterns vary. Using SSM, ambulances do not respond from fixed stations, but are "posted" to street corners on an hour to hour basis. The "posts" are selected to provide the best response times for the projected demand at that time of day.

Shift schedules are designed to provide the number of ambulances needed for the time of day and day of week projected demand. Consequently, in a typical PUM EMS provider system, ambulances typically begin duty every hour from 5:00 a.m. until noon and then the numbers start declining about 5:00 p.m. until midnight. Shift lengths are typically 8, 9, 10, 11, 12 and 24 hours in a large and busy system.

SSM enables a public utility model EMS contractor to match resources to demand more accurately than using a more traditional 'static' model of fixed staffing and fixed stations for all hours of the day and days of the week.