To understand which EMS systems work well, an important first step is the development of a typology of system configurations so they may be evaluated on a common basis. This pilot research is a first step toward developing such a typology by characterizing local EMS systems in the Mid-Atlantic region of the United States.

At its core, all health care is local and to this end, variation is something we have come to expect within EMS. It is broadly recognized that no single model, design, or delivery system will be suitable 15 for every locality, as local EMS systems must choose elements based on needs and available resources to survive and provide essential community services. As a result, EMS systems incorporate multiple agency types, response configurations, and funding streams while striving to best integrate these into a cohesive whole. The results of this study highlight noticeable differences between and within States and verified many of the expected distinctions across various categories of system size and rurality. Despite the variation observed in the structural elements assessed, EMS systems presented fairly consistent views through the survey’s opinion questions, noting pervasive system change as well as positive environments and support structures, although adequate resources remain a key concern.