Milwaukee County’s Emergency Medical Services (EMS) system offers a unique example of intergovernmental cooperation, combining county-level oversight and coordination with municipal-level service provision. Created in the 1970s, the EMS system serves all 19 municipalities in Milwaukee County.
Milwaukee County’s Office of Emergency Management (OEM) serves as system administrator while municipal fire departments contract with the county to provide both Advanced Life Support (ALS) and Basic Life Support (BLS) services. OEM’s role is to provide – among other things – administration, medical direction, education, quality assurance, data collection, and medical communications for the municipal fire departments. Meanwhile, municipal fire department personnel provide both BLS services, which include CPR, defibrillation, and administration of medications; and ALS, which includes more advanced pre-hospital and inter-facility emergency care and patient transportation.
Despite the highly coordinated nature of the EMS system in Milwaukee County, OEM and fire department leaders have expressed interest in exploring enhanced collaboration between departments and even consolidation of certain service elements. This interest stems from a variety of factors, including both human resources and financial challenges as well as a sentiment that service levels might be improved and efficiencies gained by consolidating certain functions. It also aligns with the principles set forth in the EMS Agenda 2050: A People-Centered Vision for the Future of Emergency Medical Services, published in 2019.
In this report, we address that interest by analyzing a spectrum of options that exist with regard to further EMS service sharing among the individual departments and between them and OEM. We begin by looking at options on the relatively uncomplicated end of the spectrum, such as sharing ambulance maintenance and consolidating the procurement and management of supplies. We then move on to more extensive options like enhanced collaboration and consolidation with regard to mobile integrated healthcare (MIH) services.
The final section of the report discusses the experience of Wake County, North Carolina, where fire response and protection and EMS are conducted by separate agencies. Using that community as a potential model, we envision what such an approach might look like in Milwaukee County’s North Shore, and also provide thoughts and insights on how such separation might work in other parts of the county or countywide.
Our programmatic and fiscal analysis has been aided by officials from OEM as well as the fire chiefs from the individual departments in the county, who helped identify options and provided both quantitative data and insights in a series of interviews. The study is designed not to point local officials to a specific course of action, but rather to provide sufficient analysis to allow them to consider potential improvements to an EMS system in Milwaukee County that already demonstrates a high degree of collaboration and effectiveness.