Researchers reported “3% of patients accounted for 16% of all EMS responses.”
That’s an eye-popping statistic, but a minute later, I thought, “That feels about right.”
What the national EMS utilization study found
How does this finding of very high EMS utilizers from “A national description of emergency medical services patient utilization patterns,” by Fernandez et al, published June 8, 2026 in Health Affairs Scholar match your real-world experience?
The research team analyzed more than 9.5 million EMS encounters involving 6.6 million unique patients in 2024.They reported 81.2% of patients had one EMS encounter during the study period. High utilizers (patients with 5-11 EMS encounters) and very high utilizers (patients with 12 or more EMS encounters) made up 2.46% and 0.38% of the study population respectively. In other words, nearly 25,000 patients generated nearly 500,000 EMS encounters in a single year. That’s astounding.
The very high utilizers, compared to other patients, were more likely to be enrolled in Medicaid, live in socioeconomically vulnerable communities and have chronic medical conditions. But the very high utilizers also had 40% reduced odds of hospital admission.
You’re probably nodding along, because this reflects the reality in your EMS system. Though the data doesn’t single out specific patient complaints, examine your agency’s data for similar patient attributes as well as chronic conditions, like diabetes or hypertension, mental or behavioral health problems, or drug and alcohol addiction. Your very high utilizers may also be experiencing food insecurity or homelessness, a problem that 60% of What Paramedics Want respondents reported as having a high or major impact on EMS in their community.
The persistent and wicked problem of healthcare for millions of Americans with irregular access to primary care or the inability to pay for care is either a problem for EMS to solve or for other public health and social service agencies to solve. But because 911 provides round-the-clock access to healthcare, EMS becomes the default solution for patients and communities. This is a complex problem that requires federal funding and policy solutions, statewide initiatives and novel approaches.
Meanwhile, what can your service do in your community? Here are ideas to get started.
1. Identify your very high EMS utilizers
Filter your ePCRs to identify the number of patients who have 12 or more EMS encounters per year. Without much effort, your crews might be able to name those people, where they live, and their complaints and medical history.
Make sure to engage agency privacy, compliance and legal representatives as you establish patient-specific workflows and information sharing with external partners.
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2. Review each patient’s case with the right partners
Create a committee or task force of field providers, supervisors and medical direction to review each very high utilizer. If you can, include representatives from the hospital and social services, as they likely have an interest in connecting these patients with appropriate and cost-effective healthcare and social services. Questions to answer include:
- What does the patient regularly need?
- What needs can we meet with EMS, primary care, public health and social services?
- Who can help us best address the patient’s needs?
- What is our case management action plan for the patient?
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3. Start with a small, patient-specific action plan
Set a realistic case management action plan for the patient. Start small, maybe with just the top three very high utilizers, and apply lessons learned and successes to other patients in the system. As you address the unique needs of each patient, partner with collaborators on primary care, chronic disease management, housing and food security, and employment. Other community organizations are potential partners, just approaching the patient from a different angle. EMS, as a trusted community leader, can focus those efforts and resources.
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4. Share lessons, successes and setbacks with crews
People join EMS to care for others and serve their community. Lean into this as you develop the program, begin to work with very high utilizers and transparently share the lessons learned, including successes and failures. Reducing EMS encounters with very high utilizers is likely to improve care and wellbeing for those patients, as well as improve crew availability and morale for the majority of patients who only have one EMS encounter.
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5. Measure outcomes, utilization and costs
Apply the Plan-Do-Study-Act model for improvement to your efforts. Engage your CAD and ePCR vendors to make sure you have reliable and reportable data on the patients you are trying to identify and case manage with the goal of reduced EMS encounters and better health. Report progress to staff, stakeholders, hospitals and social service and community organizations.
Calculate the costs of very high utilization patient case management and compare it to the costs of delivering frequent, ALS/BLS emergency care and hospital transport.
Depending on payer mix and service costs, many repeat EMS encounters may be under-reimbursed or uncompensated. Calculate the costs of 911 and hospital care versus a case management approach with community paramedics and social service partners as you transition the patient away from frequent 911 encounters.
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6. Recognize meaningful patient and system progress
Zero EMS encounters might not be a realistic goal for many patients, but take a bow if you can transition a patient from 12 or more encounters per year to 2-4 per year. This is a notable change for the patient and the organization. Celebrate with the patient to recognize behavior changes and health improvement that is leading to fewer EMS encounters. Many agencies celebrate cardiac arrest saves (usually less than 1% of patient encounters). It makes sense to do something similar for the very high utilization subset of patients who use a lot of resources and can have a significant impact on the organization.
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7. Act locally and advocate nationally
Appreciate the work of Fernandez et al, but minimize time spent lamenting the national scope of this problem. Instead, focus your attention and energy locally on the patients you already know and the opportunity to make an immediate impact on those patients and the EMS professionals who regularly care for them.
Through our national organizations, like NAEMT, NEMSMA, NEMSAC and NAEMSP, continue to advocate for policy change, including reimbursement for treatment in place, alternative destination transport, and community paramedicine/mobile integrated healthcare reimbursement.
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